Advertisement

Gastric Cancer

, Volume 4, Issue 1, pp 34–38 | Cite as

Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer

  • Yasuyuki Seto
  • Shouji Shimoyama
  • Jouji Kitayama
  • Kenichi Mafune
  • Michio Kaminishi
  • Takashi Aikou
  • Kuniyoshi Arai
  • Keiichiro Ohta
  • Atsushi Nashimoto
  • Ichiro Honda
  • Hisakazu Yamagishi
  • Yoshitaka Yamamura
Original article

Background.

No reports have, to date, focused on the relationship between preoperative determination of the depth of invasion and lymph node metastasis. The present study, under the leadership of the Japanese Gastric Cancer Association, was designed to form a basis for decision making in limited treatment for early gastric cancer (EGC).

Methods. From eight major hospitals in Japan, 2672 gastric cancers whose preoperative depth of invasion was mucosal(M-cancer), and 6209 EGCs, consisting of 3584 mucosal(m-) and 2625 submucosal(sm-) cancers, were collected by questionnaire. All registered patients underwent gastrectomy with D1 or more extensive lymphadenectomy between 1985 and 1998.

Results. The accuracy of preoperative diagnosis of depth of invasion of M-cancers was 80.2% (2144/2672). However, of the total of 2432 M-cancers in which no nodal involvement was observed intraoperatively (N0), histological examination of the resected specimens confirmed that lymph node metastasis was absent in 2353 (96.8%). The frequencies of lymph node metastasis in early gastric, m-, and sm-cancers were 8.9%, 2.5%, and 17.6%, respectively. Node involvement was associated with a higher frequency of undifferentiated than differentiated histology, as well as with greater tumor size. The incidences of lymph node metastasis in m-cancers with a diameter of less than 4 cm, and in sm-cancers with a diameter below 1 cm were 1.3% (37/2837) and 4.9% (4/82), respectively. These metastases rarely extended beyond the first tier.

Conclusion. N0 and M-cancers, m-cancers less than 4 cm in diameter, and sm-cancers no larger than 1 cm in diameter may be appropriate indications for limited surgery.

Key words Early gastric cancer Lymph node metastasis Preoperative diagnosis 

Copyright information

© International and Japanese Gastric Cancer Associations 2001

Authors and Affiliations

  • Yasuyuki Seto
    • 1
  • Shouji Shimoyama
    • 1
  • Jouji Kitayama
    • 2
  • Kenichi Mafune
    • 1
  • Michio Kaminishi
    • 1
  • Takashi Aikou
    • 3
  • Kuniyoshi Arai
    • 4
  • Keiichiro Ohta
    • 5
  • Atsushi Nashimoto
    • 6
  • Ichiro Honda
    • 7
  • Hisakazu Yamagishi
    • 8
  • Yoshitaka Yamamura
    • 9
  1. 1. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanJP
  2. 2. Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanJP
  3. 3. First Department of Surgery, Kagoshima University School of Medicine, Kagoshima, JapanJP
  4. 4. Department of Surgery, Tokyo Komagome Metropolitan Hospital, Tokyo, JapanJP
  5. 5. Department of Surgery, Cancer Institute Hospital, Tokyo, JapanJP
  6. 6. Division of Surgery, Niigata Cancer Center Hospital, Niigata, JapanJP
  7. 7. Department of Surgery, Chiba Cancer Center, Chiba, JapanJP
  8. 8. Department of Gastroenterological Surgery, Kyoto Prefectural University of Medicine, Kyoto, JapanJP
  9. 9. Department of Surgery, Aichi Cancer Center Hospital, Nagoya, JapanJP

Personalised recommendations