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Annals of Surgical Oncology 8:605-610 (2001)
© 2001 Society of Surgical Oncology

ORIGINAL ARTICLES

Analysis of Early (pT1) Gastric Cancer With Submucosal Invasion: Surgical Management and Possibility to Schedule Less Invasive Surgery

Shinsuke Takeno, MD, PhD, Tsuyoshi Noguchi, MD, PhD, Ryuichi Kikuchi, MD, PhD, Tetsuro Sato, MD, Yuzo Uchida, MD, PhD and Shigeo Yokoyama, MD, PhD

From the Departments of Surgery II (ST, TN, RK, TS, YU) and Pathology I (SY), Oita Medical University, Oita, Japan.

Correspondence: Address correspondence and reprint requests to: Shinsuke Takeno, MD, PhD, Department of Surgery II, Oita Medical University, 1-1 Idaigaoka, Hasama-machi, Oita, Japan 879-5593; Fax: 81-97-549-4449; E-mail: surg2{at}oita-med.ac.jp

Background: Early gastric cancer (EGC) is one of the popular targets of less invasive surgery. The aim of the present study is to clarify the possibility of scheduling a less invasive surgery for EGC cases with submucosal (SM) invasion.

Methods: Eighty cases of EGC with SM invasion were analyzed clinicopathologically and immunohistochemically. Correlations between factors that reflect cancer progression and data from endoscopic examination were investigated.

Results: Thirteen cases (16.3%) showed lymph node metastasis and the numbers of metastasis-positive lymph nodes ranged from 1 to 18. Two cases showed lymph node metastasis not only in the perigastric area, but also along the left gastric artery and the common hepatic artery. Only the tumor size showed a significant correlation with lymph node metastasis (P = .014) using the data from preoperative endoscopic examination. With respect to p53 overexpression, there was no significant correlation with pathologic factors in EGC with SM invasion. The simple protuberance types that were <2 cm in diameter had no lymph node metastasis.

Conclusions: It seems difficult to predict the progression of EGC with SM invasion from the data currently obtained by preoperative endoscopic examination. It was suggested that less invasive surgery could be scheduled only for simple protuberance type cases that were <2 cm in diameter. Radical gastrectomy and D2 lymph node dissection is required, in open surgery or laparoscopic surgery, for any other type of EGC with SM invasion.

Key Words: Early gastric cancer with submucosal invasion • Endoscopic examination • p53 • Less invasive surgery • Lymph node metastasis




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