Skip to main content
SpringerLink
Log in

Indications of a minimized scope of lymphadenectomy for submucosal gastric cancer

  • Original Articles
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A recent trend for less invasive surgery has increased consideration for a minimized scope of lymphadenectomy for submucosal cancer; however, feasibility criteria have not been precisely established.

Methods

Patterns and sites of nodal involvement were retrospectively investigated in 294 patients with solitary submucosal gastric cancer in association with other clinicopathologic characteristics, including pre- and intraoperative evaluations of cancer depth (cT) and nodal involvement (cN).

Results

Among the early (cT1) and node-negative (cN0) cancer, intestinal (≤1.5 cm) and diffuse types (<-1.0 cm) of submucosal cancer showed low incidences of nodal involvement (3%) confined to the first tier. When the cancer exceeded these cutoff diameters, positive nodes of the second tier were confined to three priority stations (left gastric, common hepatic, and celiac arteries) at an incidence of 2.3%. Perigastric and preferential dissection of these three node stations (modified D2 dissection) showed survival benefits identical to those of a conventional D2 dissection.

Conclusions

When submucosal cancer is evaluated as cT1cN0, a virtually sufficient minimized scope of lymphadenectomy is a D1 dissection for that within the cutoff diameter and a modified D2 dissection for that exceeding the cutoff diameter. These two types of dissection can even cover the infrequently observed node-positive stations and can realize no residual disease at surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Moreaux J, Bougaran J. Early gastric cancer. A 25-year surgical experience.Ann Surg 1993;217:347–55.

    Article  PubMed  CAS  Google Scholar 

  2. Guadagni S, Reed PI, Johnston BJ, et al. Early gastric cancer: follow-up after gastrectomy in 159 patients.Br J Surg 1993;80: 325–8.

    Article  PubMed  CAS  Google Scholar 

  3. Sawai K, Takahashi T, Suzuki H. New trends in surgery for gastric cancer in Japan.J Surg Oncol 1994;56:221–6.

    Article  PubMed  CAS  Google Scholar 

  4. Shimoyama S, Seto Y, Yasuda H, Kaminishi M. Wider indications for the local resection of gastric cancer by adjacent lymphadenectomy.J Surg Oncol 2000;75:157–64.

    Article  PubMed  CAS  Google Scholar 

  5. Kitamura K, Yamaguchi T, Taniguchi H, Hagiwara A, Sawai K, Takahashi T. Analysis of lymph node metastasis in early gastric cancer: rationale of limited surgery.J Surg Oncol 1997;64:42–7.

    Article  PubMed  CAS  Google Scholar 

  6. Yokota T, Saito T, Teshima S, Kikuchi S, Kunii Y, Yamauchi H. Lymph node metastasis in early gastric cancer: how can surgeons perform limited surgery?Int Surg 1998;83:287–90.

    PubMed  CAS  Google Scholar 

  7. Tsujitani S, Saito H, et al. Less invasive surgery for early gastric cancer based on the low probability of lymph node metastasis.Surgery 1999;125:148–54.

    PubMed  CAS  Google Scholar 

  8. Shimoyama S, Joujima Y, Yasuda H, Oohara T, Kaminishi M. Prospectively performed modified D1 lymphadenectomy for clinically diagnosed mucosal, node negative gastric cancer: our findings over the past decade.Int Surg 2000;85:202–8.

    PubMed  CAS  Google Scholar 

  9. Nakamura K, Morisaki T, Sugitani A, et al. An early gastric carcinoma treatment strategy based on analysis of lymph node metastasis.Cancer 1999;85:1500–5.

    Article  PubMed  CAS  Google Scholar 

  10. Shimada S, Yagi Y, Shiomori K, et al. Characterization of early gastric cancer and proposal of the optimal therapeutic strategy.Surgery 2001;129:714–9.

    Article  PubMed  CAS  Google Scholar 

  11. Kunisaki C, Shimada H, Nomura M, Akiyama H. Appropriate lymph node dissection for early gastric cancer based on lymph node metastasis.Surgery 2001;129:153–7.

    Article  PubMed  CAS  Google Scholar 

  12. Sasako M, McCulloch P, Kinoshita T, Maruyama K. Mew method to evaluate the therapeutic value of lymph node dissection for gastric cancer.Br J Surg 1995;82:346–51.

    Article  PubMed  CAS  Google Scholar 

  13. Sowa M, Kato Y, Nishimura M, Kubo T, Maekawa H, Umeyama K. Surgical approach to early gastric cancer with lymph node metastasis.World J Surg 1989;13:630–6.

    Article  PubMed  CAS  Google Scholar 

  14. Dent DM, Madden MV, Price SK. Randomized comparison of R1 and R2 gastrectomy for gastric carcinoma.Br J Surg 1988;75: 110–2.

    Article  PubMed  CAS  Google Scholar 

  15. Robertson CS, Chung SCS, Woods SDS, et al. A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer.Ann Surg 1994;220:176–82.

    Article  PubMed  CAS  Google Scholar 

  16. Bonenkamp JJ, Songun I, Hermans J, et al. Randomized comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients.Lancet 1995;345:745–8.

    Article  PubMed  CAS  Google Scholar 

  17. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomized controlled surgical trial.Cancer 1996;347:995–9.

    CAS  Google Scholar 

  18. Kurihara N, Kubota T, Otani Y, et al. Lymph node metastasis of early gastric cancer with submucosal invasion.Br J Surg 1998;85: 835–9.

    Article  PubMed  CAS  Google Scholar 

  19. Roukos DH. Current advances and changes in treatment strategy may improve survival and quality of life in patients with potentially curable gastric cancer.Ann Surg Oncol 1999;6:46–56.

    Article  PubMed  CAS  Google Scholar 

  20. Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma—2nd English Edition.Gastric Cancer 1998;1: 10–24.

    Article  PubMed  Google Scholar 

  21. Shimoyama S, Shimizu N, Kaminishi M. Type-oriented intraoperative and adjuvant chemotherapy and survival after curative resection of advanced gastric cancer.World J Surg 1999;23:284–92.

    Article  PubMed  CAS  Google Scholar 

  22. Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classification.Acta Pathol Microbiol Scand 1965;64: 31–49.

    PubMed  CAS  Google Scholar 

  23. Oohara T. Rational view of reduced radical gastrectomy for early gastric cancers.Jpn J Gastroenterol Surg 1991;24:167–71.

    Google Scholar 

  24. Kosaka T, Ueshige N, Sugaya J, et al. Lymphatic routes of the stomach demonstrated by gastric carcinomas with solitary lymph node metastasis.Surg Today 1999;29:695–700.

    Article  PubMed  CAS  Google Scholar 

  25. Bilchik AJ, Saha S, Tsioulias GJ, Wood TF, Morton DL. Aberrant drainage and missed micrometastases: the value of lymphatic mapping and focused analysis of sentinel lymph nodes in gastrointestinal neoplasms.Ann Surg Oncol 2001;8(9 Suppl):82–5.

    Google Scholar 

  26. Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H. Surgical treatment for gastric cancer: the Japanese approach.Semin Oncol 1996;23:360–8.

    PubMed  CAS  Google Scholar 

  27. Siewert JR, Kestlmeier R, Busch R, et al. Benefit of D2 lymph node dissection for patients with gastric cancer and pN0 and pN1 lymph node metastases.Br J Surg 1996;83:1144–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan

    Shouji Shimoyama MD, Hidemitsu Yasuda MD, Kenichi Mafune MD & Michio Kaminishi MD

Authors
  1. Shouji Shimoyama MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hidemitsu Yasuda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenichi Mafune MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michio Kaminishi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shouji Shimoyama MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shimoyama, S., Yasuda, H., Mafune, K. et al. Indications of a minimized scope of lymphadenectomy for submucosal gastric cancer. Annals of Surgical Oncology 9, 625–631 (2002). https://doi.org/10.1007/BF02574477

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02574477

Key Words

Search

Navigation