Lymph node metastasis in early gastric cancer

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pathology

Background:

• Early gastric cancer (EGC) management requires understanding nodal metastasis patterns.
• Lymph node status is a critical prognostic factor in gastric cancer survival.

Purpose of the Study:

• To analyze lymph node metastasis in resected early gastric cancer.
• To evaluate the impact of lymph node dissection on survival and recurrence rates.
• To identify EGC subtypes with higher risk of lymph node metastasis.

Main Methods:

• Retrospective analysis of 304 early gastric cancer resections (1969-1984).
• Lymph node status assessed in 272 cases with lymph node dissection.
• Comparison of survival and recurrence rates based on nodal status and dissection extent.

Main Results:

• 90% of cases had negative lymph nodes; 7% had Group 1 and 3% had Group 2 metastasis; Group 3 nodes were never involved.
• 10-year survival was significantly poorer for patients with positive nodes (52.8%) versus negative nodes (94.1%).
• Recurrence rates were higher in patients without lymph node dissection (9.4%) compared to those with dissection (1.5%).
• Metastasis was more frequent in macroscopically combined type, tumors >5 cm, and those with submucosal invasion.

Conclusions:

• Lymph node metastasis in EGC is infrequent but significantly affects prognosis.
• Routine lymph node dissection up to Group 2 is advisable for EGC.
• Extended lymph node dissection is particularly crucial for EGC with specific high-risk features.