Prospectively performed modified D-1 lymphadenectomy for clinically diagnosed mucosal, node negative gastric cancer: findings over the past decade

Based on retrospective analyses demonstrating the low probabilities of both lymph node metastasis and recurrence of curatively resected mucosal gastri c cancer, we have established criteria for modified D-1 lymphadenectomy (ly mphadenectomy in the perigastric region as well as along the left gastric a rtery) and performed this in a prospective manner. In this study, we evalua te our treatment strategy by reviewing the patients prospectively undergoin g modified D-1 lymphadenectomy. The clinicopathological characteristics and survival data of 138 patients who underwent modified D-1 lymphadenectomy b etween 1987 - when we first introduced endoscopic ultrasonography - and 199 6 were analyzed. The criteria for modified D-1 lymphadenectomy were mucosal , node negative gastric cancer by pre-operative and intra-operative examina tions. Depth of invasion was correctly diagnosed in 80% of the patients. Am ong the resultant submucosal gastric cancer patients, the incidence of slig ht submucosal invasion was increased in the second half-period (78%) as com pared with that in the first half-period (44%). Nodal involvement was obser ved in 4 patients (2.9%); all of them exhibited the depressed type with ulc eration and a histologically high grade of gastric cancer. Because their me tastasized lymph nodes were all confined to the perigastric region, surgica l treatment resulted in no residual cancer macroscopically. No patients suc cumbed to gastric cancer within the median and mean follow-up periods of ov er 6 years. These results suggest that our modified D-1 lymphadenectomy is an effective option for the pre-operatively and intra-operatively diagnosed mucosal, node negative gastric cancer which meets our criteria.