Abstract
Background: Early gastric cancer (EGC) is one of the popular targets of less invasive surgery. The aim of the present study is to clarify the possibility of scheduling a less invasive surgery for EGC cases with submucosal (SM) invasion.
Methods: Eighty cases of EGC with SM invasion were analyzed clinicopathologically and immunohistochemically. Correlations between factors that reflect cancer progression and data from endoscopic examination were investigated.
Results: Thirteen cases (16.3%) showed lymph node metastasis and the numbers of metastasis-positive lymph nodes ranged from 1 to 18. Two cases showed lymph node metastasis not only in the perigastric area, but also along the left gastric artery and the common hepatic artery. Only the tumor size showed a significant correlation with lymph node metastasis (P = .014) using the data from preoperative endoscopic examination. With respect to p53 overexpression, there was no significant correlation with pathologic factors in EGC with SM invasion. The simple protuberance types that were <2 cm in diameter had no lymph node metastasis.
Conclusions: It seems difficult to predict the progression of EGC with SM invasion from the data currently obtained by preoperative endoscopic examination. It was suggested that less invasive surgery could be scheduled only for simple protuberance type cases that were <2 cm in diameter. Radical gastrectomy and D2 lymph node dissection is required, in open surgery or laparoscopic surgery, for any other type of EGC with SM invasion.
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REFERENCES
Goh PM, Alponat A, Mak K, Kum CK. Early international results of laparoscopic gastrectomies. Surg Endosc 1997; 11: 650–2.
Takeshita K, Seki I, Tani M, Honda T, Saito N, Endo M. Rational lymphadenectomy for early gastric cancer with submucosal invasion: a clinicopathological study. Surg Today 1998; 28: 580–6.
Tsujitani S, Oka 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.
Akahoshi K, Chijiwa Y, Hamada S, et al. Pretreatment staging of endoscopically early gastric cancer with a 15 MHz ultrasound catheter probe. Gastrointest Endosc 1998; 48: 470–6.
Yanai H, Noguchi T, Mizumachi S, et al. A blind comparison of the effectiveness of endoscopic ultrasonography and endoscopy in staging early gastric cancer. Gut 1999; 44: 361–5.
Akahoshi K, Chijiwa Y, Sasaki I, et al. Pre-operative TN. staging of gastric cancer using a 15 MHz ultrasound miniprobe. Br J Radiol 1997; 70: 703–7.
Tseng LJ, MoLR, Tio TL, et al. Video-endoscopic ultrasonography in staging gastric carcinoma. Hepatogastroenterology 2000; 47: 897–900.
Willis S, Truong S, Gribnitz S, Fass J, Schumpelick V. Endoscopic ultrasonography in the preoperative staging of gastric cancer. Surg Endosc 2000; 14: 951–4.
Matsumoto Y, Yanai H, Tokiyama H, Nishiaki M, Higaki S, Okita K. Endoscopic ultrasonography for diagnosis of submucosal invasion in early gastric cancer. J Gastroenterol 2000; 35: 326–31.
Torii A, Sakai M, Inoue K, Yamabe H, Ueda S, Okuma M. A clinicopathological analysis of early gastric cancer: retrospective study with special reference to lymph node metastasis. Cancer Detect Prev 1994; 18: 437–41.
Maekawa S, Takeo S, Ikejiri K, Anai H, Saku M. Clinicopathologic features of lymph node metastasis in early gastric cancer. Int Surg 1995; 80: 200–3.
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.
Ohgami M, Otani Y, Kumai K, Kubota T, Kim YI, Kitajima M. Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg 1999; 23: 187–93.
Ichiyoshi Y, Oiwa H, Tomisaki S, et al. Overexpression of p53 is associated with growth pattern and prognosis in advanced gastric cancer. Hepatogastroenterology 1997; 44: 546–53.
Oiwa H, Maehara Y, Ohno S, Sakaguchi Y, Ichiyoshi Y, Sugimachi K. Growth pattern and p53 overexpression in patients with early gastric cancer. Cancer 1995; 75: 1454–9.
Japanese Research Society for Gastric Cancer. Japanese Classification Of Gastric Carcinoma. 1st English ed. Tokyo: Kanehara & Co. Ltd., 1995.
Sobin LH, Wittekind CH. UICC TNM Classification of Malignant Tumours. 5th ed. New York: Wiley-Liss, 1997.
Ichiyoshi Y, Toda T, Minamisono Y, Nagasaki S, Yakeishi Y, Sugimachi K. Recurrence in early gastric cancer. Surgery 1990; 107: 489–95.
Sano T, Sasako M, Kinoshita T, Maruyama K. Recurrence of early gastric cancer: follow-up of 1475 patients and review of the Japanese literature. Cancer 1993; 72: 3174–8.
Martin HM, Filipe MI, Morris RW, Lane DP, Silvestre F. p53 expression and prognosis in gastric carcinoma. Int J Cancer 1992; 50: 859–62.
Joypaul BV, Hopwood D, Newman EL, et al. The prognostic significance of the accumulation of p53 tumor-suppressor gene protein in gastric adenocarcinoma. Br J Cancer 1994; 69: 943–6.
Lim BH, Soong R, Grieu F, Robbins PD, House AK, Iacopetta BJ. p53 accumulation and mutation are prognostic indicators of poor survival in human gastric carcinoma. Int J Cancer 1996; 69: 200–4.
Gurel S, Dolar E, Yerci O, et al. Expression of p53 protein and prognosis in gastric carcinoma. J Int Med Res 1999; 27: 85–9.
Maehara Y, Tomoda M, Hasuda S, et al. Prognostic value of p53 protein expression for patients with gastric cancer – a multivariate analysis. Br J Cancer 1999; 79: 1255–61.
Motojima K, Furui J, Kohara N, Ito T, Kanematsu T. Expression of p53 protein in gastric carcinomas is not independently prognostic. Surgery 1994; 116: 890–5.
Muller W, Schneiders A, Hommel G, Gabbert HE. Expression of nm23 in gastric carcinoma: association with tumor progression and poor prognosis. Cancer 1998; 83: 2481–7.
Kim DH, Lee HI, Nam ES, et al. Reduced expression of the cell-cycle inhibitor p27Kip1 is associated with progression and lymph node metastasis of gastric carcinoma. Histopathology 2000; 36: 245–51.
Baba H, Ohshiro T, Yamamoto M, et al. Clinicopathological characteristics of stage 1 gastric cancer: comparison of macroscopic and microscopic findings. Hepatogastroenterology 1997; 44: 554–8.
Bonenkamp JJ, Van de Velde CJH, Sasako M, Hermans J. R2 compared with R1 resection for gastric cancer: morbidity and mortality in a prospective randomized trial. Eur J Surg 1992; 158: 413–8.
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.
Kuo WH, Lee WJ, Chen CN, Yuan RH, YuSC. Laparoscopic subtotal gastrectomy with lymphadenectomy in a patient with early gastric cancer. J Formos Med Assoc 1998; 97: 127–30.
Azagra JS, Goergen M, De Simone P, Ibanez-Aguirre J. Minimally invasive surgery for gastric cancer. Surg Endosc 1999; 13: 351–7.
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Takeno, S., Noguchi, T., Kikuchi, R. et al. Analysis of Early (pT1) Gastric Cancer With Submucosal Invasion: Surgical Management and Possibility to Schedule Less Invasive Surgery. Ann Surg Oncol 8, 605–610 (2001). https://doi.org/10.1007/s10434-001-0605-4
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DOI: https://doi.org/10.1007/s10434-001-0605-4