Surgical approach to early gastric cancer with lymph node metastasis

The clinicopathology of our series of patients (n = 486) with early gastric cancer was reviewed with special reference to metastasis to the regional lymph nodes. The incidence of lymph node metastasis was 15.8% (19/120) in patients with the protruded type of carcinoma and 11.7% (42/360) in patients with the depressed type of carcinoma. It was especially high in carcinomas of the IIa + IIc type of the former group. The incidence of lymph node involvement was higher in the group with larger tumors (greater than 30 mm) than in the group with smaller tumors (less than or equal to 30 mm). Metastatic lesions were detected in as many as 25.0% (16/64) of the cases with large tumors (greater than or equal to 50 mm); however, of the 46 cases with small tumors (less than 10 mm), 1 case had metastases to the nodes of group 1. There were 4 cases of m-cancer with metastasis to group 1 lymph nodes. Skip metastasis to group 2 lymph nodes was discovered in 4 cases. From these results, we feel that the standard operation for early gastric cancer is R2-gastrectomy including the complete removal of group 1 and 2 lymph nodes. R1-gastrectomy or local resection is thought to be sufficient for m-cancer with a lesion smaller than 10 mm in maximum diameter.