Characterization of early gastric cancer and proposal of the optimal therapeutic strategy

Background and Aims. The optimal protocol of the treatment for early gastri c cancer has not been fully established. The current study was designed to elucidate the relationship between the depth of tumors with or without an u lcer and the presence of lymph node metastasis and to establish the optimal and practical therapeutic strategy for patients with early gastric cancer Patients and Methods. A retrospective analysis of 1051 patients with early gastric cancer treated by gastrectomy with D1 or D2 lymph node dissection w as performed. The patients were, divided into those with mucosal (M) tumors and those with submucosal (SM) tumors. These 2 groups were subclassified, depending on the coexistence of ulcer or the degree of submucosal invasion, and were characterized in relation to clinicopathologic factors and 5-year prognosis. Results. The incidence of lymph node metastases from SM tumors (19.8%, 85 o f 430) was more frequent than that from M tumors (2.3%, 14 of 621) (P < .00 1). All M tumors with lymph node involvement, including tumors smaller than 1.5 cm in diameter had ulceration or ulceration scar in the lesions. SM tu mors that had invaded less than 200 <mu>m in debth (SM1a) had significantly less lymph node involvement than those with deeper invasion. The node meta stases were confined to epigastric lymph nodes (N1) in both M tumors with u lceration or ulceration scar and SM1a tumors. Conclusions. All macroscopic M tumors without ulceration or ulceration scar should be considered for endoscopic mucosal resection. The need for reoper ation for a formal gastrectomy with lymphadenectomy or a limited surgical o peration will vary depending on the pathologic analysis of endoscopic mucos al resection specimens (depth of invasion, presence of ulceration).