Long-term results of operation for carcinoma of the stomach in T1/T2 stages: critical evaluation of the concept of early carcinoma of the stomach.

BACKGROUND

The significance of nodal metastasis in patients with early gastric cancer (ECG) (T1) is unknown. It has been suggested that patients with T2, N0 carcinoma of the stomach have a comparable survival rate to patients with T1 carcinoma of the stomach.

STUDY DESIGN

A retrospective review and survival analysis of 321 patients with T1/T2 adenocarcinoma of the stomach treated between 1979 to 1991 were performed.

RESULTS

Patients were divided into four groups: group 1, 214 patients with node-negative EGC (T1, N0); group 2, 13 patients with node-positive EGC (T1, N+); group 3, 49 patients with node-negative T2 disease (T2, N0); and group 4, 45 patients with node-positive T2 disease (T2, N+). Excluding deaths from causes other than recurrence, the survival rate for patients in groups 1 and 3 was 100 percent, in contrast to the ten-year survival rate of 72.7 percent for group 2 and 62.5 percent for group 4 patients (p < 0.001, groups 1 versus 2, groups 3 versus 4). The ten-year survival rate for patients with node-negative T2 disease (group 3, 100 percent) was significantly better than that of patients with node-positive EGC (group 2, 72.7 percent) (p < 0.001). Although differences in the survival rates were noted according to lymphatic or venous invasion and whether or not patients had EGC or T2 carcinoma, the most significant factor was lymph node invasion.

CONCLUSIONS

The postoperative survival rate for patients with node-positive EGC was poorer than that for those with node-negative T2 carcinomas. Reevaluation of the concept of EGC may be necessary. Post-operative chemotherapy does not appear necessary in patients with T2, N0 disease.