Intramucosal-lymphatic invasion has a slight impact on lymph node metastasis in patients with early gastric cancer

  • Shizuki Sugita
  • Takahiro KinoshitaEmail author
  • Takeshi Kuwata
  • Masanori Tokunaga
  • Akio Kaito
  • Masahiro Watanabe
  • Akiko Tonouchi
  • Reo Sato
  • Masato Nagino
Original Article



Lymphatic invasion (LI) is associated with lymph node metastasis (LNM) and a poor prognosis in patients with early gastric cancer (EGC). Although the impact of the LI volume on LNM has been described, no reports have assessed the impact of its depth on LNM.


A total of 360 EGC patients with pathologically proven LI who underwent radical gastrectomy with lymphadenectomy between January 2005 and June 2018 at our institution were extracted from our database. Patients were divided into 2 groups: the mLI group, in which LI was limited to the muscularis mucosae (n = 34); and the smLI group, in which LI reached the submucosal region (n = 326). Clinicopathological features, including the LNM incidence, were compared between the groups.


LNM was recognized in 3 patients (9%) in the mLI group and 101 (31%) in the smLI group (P = 0.005). In the mLI group, LNM was not recorded in any patients who met the curative criteria of ESD other than mLI.


LI limited to the mucosal region does not seem to be a strong indicator for LNM. When pathological findings of an endoscopic submucosal dissection specimen show only mLI as a non-curative criterion, the probability of LNM may be very low.


Early gastric cancer Lymphatic invasion Lymph node metastasis Endoscopic submucosal dissection 



We thank H. Nikki March, PhD, from Edanz Group ( for editing a draft of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Gastric SurgeryNational Cancer Center Hospital EastKashiwaJapan
  2. 2.Department of Pathology and Clinical LaboratoriesNational Cancer Center Hospital EastKashiwaJapan
  3. 3.Exploratory Oncology Research and Clinical Trial Center (EPOC)National Cancer CenterKashiwaJapan
  4. 4.Division of Surgical Oncology, Department of SurgeryNagoya University Graduate School of MedicineNagoyaJapan

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