Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer
Endoscopic resection (ER) has been accepted as minimally invasive treatment in patients with early gastric cancer (EGC) who have a negligible risk of lymph node metastasis. It has already been determined which lesions in differentiated-type EGC present a negligible risk of lymph node metastasis, and ER is being performed for these lesions. In contrast, no consensus has been reached on which lesions in undifferentiated-type (UD-type) EGC present a negligible risk for lymph node metastasis, nor have indications for ER for UD-type EGC been established.
We investigated 3843 patients who had undergone gastrectomy with lymph node dissection for solitary UD-type EGC at the Cancer Institute Hospital, Tokyo, and the National Cancer Center Hospital, Tokyo. Seven clinicopathological factors were assessed for their possible association with lymph node metastasis.
Of the 3843 patients, 2163 (56.3%) had intramucosal cancers and 1680 (43.7%) had submucosal invasive cancers. Only 105 (4.9%) intramucosal cancers compared with 399 (23.8%) submucosal invasive cancers were associated with lymph node metastases. By multivariate analysis, tumor size 21 mm or more, lymphatic-vascular capillary involvement, and submucosal penetration were independent risk factors for lymph node metastasis (P < 0.001, respectively). None of the 310 intramucosal cancers 20 mm or less in size without lymphatic- vascular capillary involvement and ulcerative findings was associated with lymph node metastases (95% confidence interval, 0–0.96%).
UD-type intramucosal EGC 20 mm or less in size without lymphatic-vascular capillary involvement and ulcerative findings presents a negligible risk of lymph node metastasis. We propose that in this circumstance ER could be considered.
Key wordsUndifferentiated-type early gastric cancer Lymph node metastasis Risk factor Endoscopic resection
- 8.Tokunaga M, Hiki N, Fukunaga T, Seto Y, Sano T, Yamaguchi T, et al. Effects of reconstruction methods on a patient’s quality of life after a proximal gastrectomy: subjective symptoms evaluation using questionnaire survey. Langenbecks Arch Surg 2008. doi:10.1007/s00423-008-0442-z.Google Scholar
- 12.Japanese Gastric Cancer Association. Gastric cancer treatment guideline. 2nd ed. (in Japanese). Tokyo: Kanahara; 2004.Google Scholar
- 24.Hiki Y. Endoscopic mucosal resection (EMR) for early gastric cancer. Jpn J Surg 1996;97:273–278.Google Scholar
- 25.Ohgami M, Otani Y, Kumai K, Kubota T, Kitajima M. Laparoscopic surgery for early gastric cancer (in Japanese with English abstract). Jpn J Surg 1996;97:279–285.Google Scholar
- 27.Oizumi H, Matsuda T, Fukase K, Monma T, Furusawa A, Mito S. Endoscopic resection for early gastric cancer: the accrual procedure and clinical evaluation (in Japanese with English abstract). Stomach Intestine 1991;26:289–300.Google Scholar
- 28.Fujii K, Okajima K, Isozaki H, Hara H, Nomura E, Sako S, et al. A clinicopathological study on the indications of limited surgery for submucosal gastric cancer. Jpn J Gastroenterol Surg 1998;31:2055–2062.Google Scholar
- 38.Oyama T, Kikuchi Y. Aggressive endoscopic mucosal resection in the upper GI tract — Hook knife EMR method. Minim Invasive Ther Allied Technol 2002;11:291–295.Google Scholar