Early mucosal gastric cancer with extra-perigastric (n2) lymph node metastasis

During the 10 years from 1977 to 1986, a total of 314 cases of early gastric cancer were resected. Of these, 43 (14%) had lymph node metastases, with 6 cases of mucosal (m-) cancer and 37 of submucosal (sm-) cancer. Among the patients with positive lymph node metastases, 37 (86%) had metastases in the Group 1 regional lymph nodes. Eight patients had metastases in the Group 2 lymph nodes, and these involved 2 cases of m-cancer and 6 of sm-cancer. Lymph node metastasis is generally believed to occur in only about 3% of m-cancer, and then mainly in the Group 1 lymph nodes. Here, 2 rare cases of early gastric m-cancer with positive extra-gastric lymph node metastasis are reviewed in detail, with special attention to the surgical management.