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Clinical Significance of Lymphatic Involvement in Intramucosal (pT1a) Gastric Cancer Resected by Endoscopic
Katsunori Matsueda1, Yoshiyasu Kono1, Koji Miyahara2
1Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan.
Journal of Gastroenterology and Hepatology
|December 18, 2024
Summary
Endoscopic resection of early gastric cancer (pT1a) with lymphatic involvement shows a low risk of metastasis. Pure differentiated-type lesions have virtually no risk of metastatic recurrence after endoscopic submucosal dissection.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Lymphatic involvement is occasionally found in intramucosal (pT1a) gastric cancer treated with endoscopic resection.
- The clinical significance of lymphatic involvement and its association with metastatic risk are not well understood.
Purpose of the Study:
- To investigate the clinical significance of lymphatic involvement in pT1a gastric cancer treated by endoscopic submucosal dissection (ESD).
- To quantify the risk of metastasis in pT1a gastric cancers with lymphatic involvement.
Main Methods:
- Retrospective cohort study of 6797 patients with pT1a gastric cancers treated with ESD.
- Exclusion of 49 uncommon gastric cancer types.
- Analysis of metastasis risk by comparing outcomes in patients who had additional surgery versus those followed up for over 3 years.
Main Results:
- 41 lesions (0.6%) among 6748 pT1a cancers showed lymphatic involvement.
- Metastasis was identified in 1 of 40 analyzed patients (2.5%) with lymphatic involvement.
- No metastasis was detected in 25 patients with pure differentiated-type lesions (0.0%).
Conclusions:
- The risk of metastatic recurrence after ESD for pT1a gastric cancer with lymphatic involvement is low.
- Pure differentiated-type lesions with lymphatic involvement have a particularly low risk of metastasis.
