Gastric carcinoma confined to the Muscularis propria: How can we detect, evaluate, and cure intermediate-stage carcinoma of the stomach?

OBJECTIVE: The most important surgical strategy for advanced gastric cancer is its detection at the curative stage. The aim of this study was to chara cterize the curable intermediate-stage gastric carcinomas. METHODS: Of 1120 consecutive patients who undervent gastric resection for p rimary gastric cancer from 1979 through 1996, 94 patients were histological ly diagnosed as having cancer confined to the muscularis propria (mp cancer ), analyzed clinicopathologic ally, and compared with patients with early a nd serosal cancers. RESULTS: The operative incidence of mp cancer was around 8% among cases of gastrectomy, and the ratio of mp cancer to advanced cancer began to increas e in 1991. Mp cancer was at a statistically intermediate stage, between ear ly and serosal cancers in terms of symptoms, surgical curability (96%), siz e and histology of the tumor, and the rate of lymph node metastasis (46%). Preoperative assessments of tumor depth were unclear using radiology and en doscopy; however, 35% of 31 cases studied were diagnosed precisely by endos copic ultrasonography (EUS). Accuracy of lymph node metastasis diagnosis wa s the same (65%) by preoperative EUS and by surgeon; however, sensitivity o f the surgeon's assessment was higher (69% vs 38%) and specificity of EUS w as higher (83% vs 39%). The 5-yr survival rate was 85%, which was significa ntly better than that of serosal cancer and similar to that of early cancer . Patient outcome was not affected by lymph node metastasis or macroscopic type of tumor. CONCLUSIONS: Mp cancer should be considered an intermediate-stage cancer. S urgery with level 2 lymph node dissection should provide a cure rate simila r to that for early cancer. (Am J Gastroenterol 1999;94:2251-2255. (C) 1999 by Am. Cell. of Gastroenterology).