LYMPH-NODE METASTASIS OF EARLY GASTRIC-CANCER WITH SUBMUCOSAL INVASION

Background A clinicopathological study of early gastric cancer with su bmucosal invasion was carried out in relation to lymph node metastasis . Methods A retrospective study was conducted of 245 patients with sub mucosal gastric cancer treated by gastrectomy combined with D-2 lymph node resection between 1985 and 1994 in a university hospital. Results Lymph node metastasis was observed in 34 patients (14 per cent). The mortality rate due to recurrence in patients with lymph node metastasi s (three of 34) was significantly higher than in those without lymph n ode metastasis (five (2 per cent) of 211) (chi(2) = 3.95, 1 d.f., P < 0.05). Tumour size, depth of invasion, lymphatic involvement of cancer cells and preoperative diagnosis of advanced cancer correlated signif icantly with the presence of lymph node metastasis. When the submucosa l carcinomas were classified into three categories according to depth of invasion by dividing the submucosal (sm) layer into three equal par ts, sml, sm2 and sm3, the incidence of lymph node metastasis increased from 2 per cent to 12 and 20 per cent respectively. Conclusion When t he pathological report reveals sm1 invasion after laparoscopic or endo scopic surgery, reoperation should not be necessary because sm1-carcin omas with diameters of less than 2 cm do not usually metastasize to th e lymph nodes.