Relationship between Ulcerative Lesions in the Tumor and Lymph Node Involvement in Gastric Cancer with Submucosal Invasion

Soichi Tomimatsu, Takashi Ichikura, Hirohumi Ishikawa, Kazuhiko Uefuji, Shoetsu Tamakuma

First Department of Surgery, National Defense Medical College

One hundred and seventy-five patients with gastric cancer invading the submucosa with a gross appearance of the depressed or combined type were analyzed to determine the relationship between the presence of ulcerative lesions in the tumor and lymph node involvement. They were divided into three groups: those with an ulcer or ulcer scar (U1) limited to the submucosa in the tumor (U1-II group), those with U1 beyond the submucosa (U1-III, IV group) and those without any U1 (control group). The presence of the U1 in the tumor was significantly correlated with younger age, undifferentiated tumor and lymphatic invasion. There were more patients with nodal involvement in the U1-II or U1-III, IV groups than in the control group irrespective of the histologic type of the tumor (p<0.05). Lymph node involvement was observed in 11 (31.4%) of the 35 patients in the U1-II group, 8 (47.1%) of the 17 patients in the U1-III, IV group and 11.4% in the control group (p<0.01). However, the Uls of resected specimens were detected with the naked eye in only 31.4% of the U1-II group and 76.4% of the U1-III, IV group. In conclusion, the presence of a U1 in the tumor can be a useful indicator for further treatment by lymphadenectomy when histologic examination reveals submucosal invasion after localized excision. Progress in preoperative diagnosis of the U1 is mandatory for conservative treatment of gastric cancer invading the submucosa.

Key words
ulcerative lesions in gastric cancer, gastric cancer with submucosal invasion, lymph node metastases, diagnosis of ulcerative lesions in early gastric cancer, conservative operation for early gastric cancer

Reprint requests
Soichi Tomimatsu First Department of Surgery, National Defense Medical College
3-2 Namiki, Tokorozawa, 359 JAPAN

Accepted
May 8, 1996

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