Clinicopathological investigation of early gastric carcinoma; is less invasive surgery right for early gastric carcinoma?

BACKGROUND/AIMS: The detection of early gastric carcinoma (EGC) has increased worldwide in recent years due to advances in endoscopic techniques and equipment. The objectives of this study were to compare the clinicopathological findings of patients with N1 node-negative and positive EGC, and then consider the treatment options.

METHODOLOGY

A total of 814 cases of gastric carcinoma in patients who underwent surgical procedures between 1981 and 1999 at Kochi Medical School were studied. In 375 patients with EGC, surgicopathological parameters were analyzed.

RESULTS

Lymph node metastasis was observed in 28 patients (7.4%) with EGC. EGC of the flat type with submucosal invasion, lymphatic permeation, and tumor size larger than 4 cm was associated with higher risk factors of lymph node metastasis. In this study, the location and histological classification of EGC were not related to lymph node metastasis. However, lymph node metastasis was not recognized in submucosal invasive gastric carcinomas less than 1 cm in size.

CONCLUSIONS

In the EGC limited to the mucosa or smaller than 1 cm, when the tumor infiltrated the submucosal layer, it could be managed by less invasive surgery without standard lymphadenectomy, and gastrectomy with lymphadenectomy was necessary for patients with EGC who had a high risk of lymph node metastasis.