Lymph node metastasis in early gastric cancer: How can surgeons perform limited surgery?

Background: In Japan, the standard treatment policy for all potentially cur able patients with gastric cancer is radical resection, including extensive lymph node dissection. The extent of lymph node dissection remains a contr oversial issue in the management of early gastric cancer. A recent trend in the surgical treatment of early gastric carcinoma has been to limit surger y such that a complete cure is achieved and the patient's quality of life i s improved. However approximately 10% of early gastric cancers are reported to be node positive and little is known about the protocol of surgical tre atment most appropriate for the treatment of early gastric cancer. In this study, we examined the clinicopathological features that could distinguish node-positive cancer from node-negative cancer. Patients and Methods: The clinicopathological features of 26 patients with node-positive early gastric cancer were reviewed from the database of gastr ic cancer at the Department of Surgery, Sendai National Hospital. They were compared with those of 239 patients with node-negative cancer. Results: Tumor size, macroscopic appearance, depth of cancer invasion, hist ological growth pattern and lymphatic invasion were associated with lymph n ode metastasis, Node-positive patients with early gastric cancer had a poor er survival rate than node-negative patients (P < 0.05), Conclusion: Limited surgery, such as local resection without lymphadenectom y, can be performed for elevated or flat type cancer, or tumor < 2 cm in di ameter. Lymphadenectomy is recommended to achieve higher possible cure rate s for other early gastric cancers.