Surgical Approach for Early Gastric Cancer with Special Reference to Lymph Node Metastasis

Masatsugu Kitamura, Kuniyoshi Arai, Kaoru Miyashita

Tokyo Metropolitan Komagome Hospital

We investigated the standards for determining the surgical procedure for early gastric cancer according to the relationship between age, depth and macroscopic type of cancer, tumor size, histological type of cancer and lymph node metastasis, and that between the degree of lymph node dissection and prognosis of the disease. The subjects were 580 patients suffering from early gastric cancer. The incidences of lymph node metastasis in cases of mucosal cancer and submucosal cancer were 9/304 (3.0% and 49/276 (17.8%), respectively. The incidence of lymph node metastasis among the total cases of early gastric cancer, which tended to decrease with age, was significantly lower in patients over 70 years old than the incidence in patients younger than 50 (p<0.05). Concerning macroscopic types, were found a high incidence of lymph node metastasis in the cases with depressed type (IIc). The incidence of lymph node metastasis rose with increase in the major axis. On histological investigation, we obtained similar results in both cases of mucosal and of submucosal cancer. The incidence of lymph node metastasis in the differentiated types was significantly lower than in the undifferentiated types (p<0.05). In particular in patients over 70 years old with the differentiated type, the incidence of lymph node metastasis was low. The metastasis to the lymph node in the second group could be seen only in No. 7 lymph node. As for the relationship between the degree of lymph node dissection and prognosis of patients, there was no difference between lymph node dissection in the first group (R1) and in the second group (R2). Consequently, in patients over age 70 suffering from gastric cancer with complications, if gastric cancer is theoretically regarded as differentiated mucosal cancer, lymph node dissection of R1 (including No. 7 lymph node in the second group) is probably the proper method.

Key words
early gastric cancer, lymph node metastasis for early gastric cancer, limited lymph node dissection of early gastric cancer

Reprint requests
Masatsugu Kitamura Department of Surgery, Tokyo Metropolitan Komagome Hospital
3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113 JAPAN

Accepted
September 12, 1992

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