Analysis of lymph node metastasis in early gastric cancer: rationale of limited surgery

Since the majority of patients with early gastric cancer show long-term survival after surgery, a special attention must be directed to preserving gastric function in these patients. Little is known about the protocol of surgical treatment appropriate for early gastric cancer patients. This study was designed to determine the appropriate surgical procedure for early gastric cancer.

The clinicopathologic features of 52 patients with node-positive early gastric cancer were reviewed retrospectively from hospital records between 1969 and 1994 and were compared with those of 582 patients with node-negative early gastric cancer. Nodal status of positive nodes in the 52 cases was investigated.

Depth of invasion, lymph vessel invasion, and tumor size were associated with lymph mode metastasis. Node-positive patients with early gastric cancer had a poorer survival rate than node-negative patients (P < 0.05). Patients with five or more positive nodes and positive nodes distant from the common hepatic artery showed an extremely poor prognosis.

The surgical procedures most appropriate for the treatment of early gastric cancer are as follows: (1) local gastric resection without lymphadenectomy for mucosal cancers of < 2 cm in diameter and for elevated submucosal cancers of < 1 cm in diameter, (2) gastrectomy with dissection of the perigastric nodes, the nodes along the left gastric artery and the common hepatic artery, for the treatment of other early gastric cancers.