Regional lymph node metastasis of early gastric cancer

Of 122 patients hospitalized for early gastric cancer in 1974-1989, 15 were histologically found to have regional lymph node metastases. Tumor invasion was limited to the mucosa in 3 cases and to the submucosa in 12. An ulcer or ulcer scar was found in the tumor in 12 cases. Metastasis had occurred only to the perigastric nodes in 13 cases and also along the left gastric and/or common hepatic arteries in two. Preoperative endoscopic injection of Chinese ink into the submucosa revealed a high rate of uptake in regional lymph nodes along the left gastric, splenic and common hepatic arteries. Patients with early cancer should undergo gastrectomy with lymphadenectomy, particularly if the cancer contains an ulcer or has invaded the submucosa. If the patient's general health and life expectancy are poor, restricted surgery or endoscopic treatment should be considered.