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Is lymphadenectomy needed for all submucosal gastric cancers?
H Yamada1, Z Nihei, T Yamashita
1Second Department of Surgery, Tokyo Medical and Dental University, Japan.
Objective:
To find out if it is feasible to extend the indication for local resection of submucosal gastric cancer without increasing the risk of lymph node metastases.
Design:
Retrospective study.
Setting:
University hospital, Japan.
Subjects:
104 patients with gastric cancer confined to the submucosal layer who underwent conventional gastrectomy with lymphadenectomy.
Interventions:
The risk of nodal metastases was analysed retrospectively depending on the depth of submucosal invasion, size of the tumour, and other clinicopathological findings.
Main Outcome Measures:
The degree of submucosal invasion, size of the tumour, and incidence of lymph node metastasis.
Results:
15/104 patients (14%) had lymph node metastases. No patient in whom submucosal invasion was less than 500 microm or tumour was less than 15 mm in diameter developed lymph node metastases. Fewer patients had lymphatic permeation (37/89) and venous involvement (21/89) in the group without lymph node metastases.
Conclusion:
These data seem to support the hypothesis that early, minimally invasive, gastric cancer measuring < 15 mm in diameter could be treated by endoscopic mucosal or local resection, and gastrectomy with lymphadenectomy might be unnecessary.