A Clinicopathological Study on the Indications of Limited Surgery for Submucosal Gastric Cancer

Keizo Fujii, Kunio Okajima, Hiroshi Isozaki, Hitoshi Hara, Eiji Nomura, Shozo Sako, Nobuyuki Izumi, Hideaki Mabuchi, Kanni Nashiguchi

Department of General and Gastroenterological Surgery, Osaka Medical College

To determine whether the limited surgery is possible for the early gastric cancer invading submucosal layer (sm-cancer), a total of three hundred and seventy-eight cases with sm-cancer were investigated clinicopathologically. We divided sm-cancers into the following three subgroups according to the degree of cancerous invasion: sm1 group with minute submucosal invasion, sm2 group with invasion to the mid-submucosal layer, and sm3 group with deep and massive submucosal invasion near to the proper muscle. As a result, there was no lymph node metastasis in cases of sm-cancer less than 10 mm, in cases of the elevated type cancer less than 20 mm, or in cases of the differentiated sm1 or sm2-cancer less than 20 mm. However, the reports on the micro lymph node metastasis, which could not be detected in the conventional pathological examination, suggests that the evaluation of lymph node metastasis using conventional method is insufficient as an indicator for the plan of limited surgery. Consequently, to determine the strict indications of limited surgery, we examined lymphatic invasion of the cancerous lesion which related closely to lymph node metastasis. The examination of lymphatic invasion demonstrated that lymph node dissection can be omitted in cases of differentiated sm1-cancer less than 10 mm. However, the preoperative diagnosis of sm1 of less than 10 mm had been difficult. Thus, the lymphadenectomy should be performed for cases diagnosed as SM-cancer preoperatively at the present time.

Key words
gastric cancer with submucosal invasion, degree of submucosal invasion, limited surgery for early gastric cancer

Reprint requests
Keizo Fujii Department of General and Gastroenterologicl Surgery, Osaka Medical College
2-7 Daigaku-machi, Takatsuki, 569-8686 JAPAN

Accepted
June 10, 1998

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