Early gastric cancer: a single-institution experience on 60 cases

The 5-year survival rate of early gastric cancer (EGC) is 85-100% after "curative" resection, as compared to 20-30% in advanced gastric cancer (AGC). Because of this relatively high cure rate, the interest in the diagnosis and therapy of EGC has been steadily increasing. The present study, based on 60 EGCs, in a single-institution, is aimed at critical evaluating the diagnostic procedures and surgical options.

Sixty patients with early gastric cancer (36 men and 24 women; median age, 61 years; range, 28-84) were diagnosed and operated on. They represented 21% of all patients with gastric cancer (281) treated in the period January 1987 to December 2001. The most frequent symptom was epigastric pain (84%). Barium upper gastrointestinal radiography findings were strongly suggestive of malignancy in 56 cases (93%). Preoperative histopathological diagnosis of adenocarcinoma was performed in 57 cases (95%). In 3 cases (5%) severe epithelial dysplasia (associated with ulcer) was the first diagnosis, but the final diagnosis, on the basis of resected specimens, was well differentiated adenocarcinoma. The primary surgical procedure included: a) subtotal distal resection (49 cases); b) total gastrectomy (6) for proximal neoplastic extension; c) proximal gastric resection (2) for cardial cancer; d) degastro-total gastrectomy (3) for cancer of the stump. Two patients, previously treated with conservative surgery, underwent degastro-total gastrectomy for neoplastic microfocal extension to the resection margin and for early anastomotic recurrence, respectively. Mural infiltration was limited to the mucosa and submucosa in 36 and 24 cases, respectively. Lymph node metastases were found in 3 mucosal and 9 submucosal tumor cases, involving either the first and second echelon. No operative deaths or postsurgical complications occurred in this series. In the follow-up period (median, 63 months; range, 3-178) 7 patients died due to other causes; 1 developed liver metastases, another developed oropharyngeal cancer and 2 died of biopsy-proven lung cancer without evidence of recurrent or metastatic gastric cancer.

The clinical presentation of EGC is aspecific. Preoperative endoscopy with multiple biopsies remains the most sensitive diagnostic procedure. For treatment, subtotal distal gastric resection with lymphadenectomy is the gold standard, but in some instances total gastrectomy may be indicated. Accurate pathological examination establishes the depth of infiltration, as well as the superficial extension of tumors and lymph node status. Although the prognosis of EGC is favorable, a medium-term follow-up should be planned.