ASSESSING THE SUITABILITY OF GASTRIC-CARCINOMA FOR LIMITED RESECTION - ENDOSCOPIC PREDICTION OF LYMPH-NODE METASTASES

Some early gastric carcinomas are free of lymph node involvement; howe ver, the pathosis of these carcinomas is neither well understood nor r eflected in the choice of less extensive treatment. We investigated th e relation of nodal involvement to pathologic findings of the resected specimens. We present promising standards for predicting the nodal st atus of early gastric carcinomas, contributing to the indication for l imited surgery. The relation of lymph node metastasis to tumor size, i nfiltration depth, macroscopic appearance, and histologic type of earl y gastric carcinomas were investigated in 1470 patients with a single primary early gastric carcinoma. Of these carcinomas, 763 were limited to the mucosa (mucosal carcinoma) and 707 to the submucosa (submucosa l carcinoma). The overall incidence of lymph node metastasis was 9.0%: 2.1% in mucosal carcinomas and 16.5% in submucosal ones, with a signi ficant (p < 0.001) difference of nodal involvement between the two. Th e macroscopically elevated or compound-type carcinomas 10 mm or less i n diameter were all node-negative, whereas some depressed-type carcino mas were node-positive. The incidence of undifferentiated carcinomas i ncreased with tumor diameter, irrespective of whether they mere mucosa l or submucosal carcinomas, and they were significantly more node-posi tive than were differentiated carcinomas: p < 0.001 for mucosal carcin omas and p < 0.05 for submucosal ones. The carcinomas satisfying the f ollowing criteria are node-negative and eligible for limited surgery: (1) mucosal carcinoma; (2) elevated lesion <10 mm in diameter; (3) dif ferentiated adenocarcinoma; and (4) no ulcer or ulcer scar. The other carcinomas are potentially node-positive and standard surgery is recom mended.