An early gastric carcinoma treatment strategy based on analysis of lymph node metastasis

BACKGROUND, Newly developed therapies for early gastric carcinoma attempt t o consider patients' quality of life, but the applicability and effectivene ss of these treatments remain undetermined. METHODS. Clinicopathologic data of 612 consecutive patients with early gast ric carcinoma, all of whom were treated by D1 and D2 gastrectomy, were anal yzed. Patients with and without lymph node metastases were compared in rela tion to age and gender distributions, surgical procedures, histopathology o f the tumors, 5-year prognosis, and in reference to the preoperative and in traoperative assessments. RESULTS, The overall incidence of lymph node metastases was 5.7%. Tumor dep th and size were related to lymph node metastases judged by univariate and multivariate analyses. Patients with mucosal tumors showed no relation betw een metastatic rate and tumor size, whereas those with submucosal turners s howed an increasing metastatic rate with tumor size. In all cases but one, lymph node metastases were confined to lymph node stations defined as Group 1 locations. Preoperative endoscopic ultrasonography showed a 55% diagnost ic accuracy in determining tumor depth and a 15% sensitivity in diagnosing lymph node metastases. CONCLUSIONS. Patients with early gastric carcinoma may be candidates for en doscopic mucosal resection if their tumor is confined to the mucosa and mea sures < 1 cm in greatest dimension. Other limited resections including D1 g astrectomy or standard D2 gastrectomy based on tumor depth and size are app ropriate. Based on the current study findings, the authors propose a useful algorithm for managing such patients. (C) 1999 American Cancer Society.