Park Do-Joong, Lee Hyeon-Kook, Lee Hyuk-Joon, Lee Hye-Seung, Kim Woo-Ho, Yang Han-Kwang, Lee Kuhn-Uk, Choe Kuk-Jin
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul 110-744, Korea.
World J Gastroenterol. 2004 Dec 15;10(24):3549-52. doi: 10.3748/wjg.v10.i24.3549.
To explore the feasibility of performing minimally invasive surgery (MIS) on subsets of submucosal gastric cancers that are unlikely to have regional lymph node metastasis.
A total of 105 patients underwent radical gastrectomy with lymph node dissection for submucosal gastric cancer at our hospital from January 1995 to December 1995. Besides investigating many clinicopathological features such as tumor size, gross appearance, and differentiation, we measured the depth of invasion into submucosa minutely and analyzed the clinicopathologic features of these patients regarding lymph node metastasis.
The rate of lymph node metastasis in cases where the depth of invasion was <500 microm, 500-2000 microm, or >2000 microm was 9% (2/23), 19% (7/36), and 33% (15/46), respectively (P<0.05). In univariate analysis, no significant correlation was found between lymph node metastasis and clinicopathological characteristics such as age, sex, tumor location, gross appearance, tumor differentiation, Lauren's classification, and lymphatic invasion. In multivariate analysis, tumor size (>4 cm vs <=2 cm, odds ratio = 4.80, P = 0.04) and depth of invasion (>2000 microm vs <=500 microm, odds ratio = 6.81, P = 0.02) were significantly correlated with lymph node metastasis. Combining the depth and size in cases where the depth of invasion was less than 500 microm, we found that lymph node metastasis occurred where the tumor size was greater than 4 cm. In cases where the tumor size was less than 2 cm, lymph node metastasis was found only where the depth of tumor invasion was more than 2000 microm.
MIS can be applied to submucosal gastric cancer that is less than 2 cm in size and 500 microm in depth.
探讨对不太可能发生区域淋巴结转移的胃黏膜下癌亚组进行微创手术（MIS）的可行性。
1995年1月至1995年12月，我院共有105例患者因胃黏膜下癌接受了根治性胃切除术并进行淋巴结清扫。除了研究肿瘤大小、大体外观和分化程度等多种临床病理特征外，我们还精确测量了黏膜下层的浸润深度，并分析了这些患者淋巴结转移的临床病理特征。
浸润深度＜500微米、500 - 2000微米或＞2000微米的病例中，淋巴结转移率分别为9%（2/23）、19%（7/36）和33%（15/46）（P＜0.05）。单因素分析中，未发现淋巴结转移与年龄、性别、肿瘤位置、大体外观、肿瘤分化、劳伦分类和淋巴管浸润等临床病理特征之间存在显著相关性。多因素分析中，肿瘤大小（＞4厘米对≤2厘米，比值比 = 4.80，P = 0.04）和浸润深度（＞2000微米对≤500微米，比值比 = 6.81，P = 0.02）与淋巴结转移显著相关。在浸润深度小于500微米的病例中，结合深度和大小发现，肿瘤大小大于4厘米时发生淋巴结转移。在肿瘤大小小于2厘米的病例中，仅在肿瘤浸润深度超过2000微米时发现淋巴结转移。
MIS可应用于大小小于2厘米且深度小于500微米的胃黏膜下癌。
