Torii A, Sakai M, Inoue K, Yamabe H, Ueda S, Okuma M
First Department of Internal Medicine, Kyoto University Hospital, Japan.
Cancer Detect Prev. 1994;18(6):437-41.
We reviewed 217 cases of early gastric cancer (EGC) resected from 1978 through 1988. To determine the indications for curative resection by endoscopic mucosectomy (EM) for EGC, we paid special attention to lymph node metastasis examined after gastrectomy. The overall incidence of lymph node metastasis was 12.4%. It was 3.4% for mucosal (m-) cancer and 23.5% for submucosal (sm-) cancer. The maximum diameter of the lesion, depth of cancerous invasion, and location of the lesion showed positive correlations with lymph node involvement (p < 0.05). EGCs less than 20 mm in diameter had no lymph node metastasis. Pieces of mucosa about 20 mm in diameter on the average could be obtained with a single EM procedure. EGC with ulceration had a higher incidence of lymph node involvement than did that without ulceration. We conclude that if EM reveals an intramucosal gastric carcinoma less than 20 mm in diameter without ulceration, curative resection by EM is indicated.
我们回顾了1978年至1988年期间切除的217例早期胃癌（EGC）病例。为了确定通过内镜黏膜切除术（EM）对EGC进行根治性切除的指征，我们特别关注了胃切除术后检查的淋巴结转移情况。淋巴结转移的总体发生率为12.4%。黏膜（m-）癌为3.4%，黏膜下（sm-）癌为23.5%。病变的最大直径、癌浸润深度和病变部位与淋巴结受累呈正相关（p<0.05）。直径小于20mm的EGC无淋巴结转移。单次EM手术平均可获得直径约20mm的黏膜组织块。有溃疡的EGC淋巴结受累发生率高于无溃疡者。我们得出结论，如果EM显示直径小于20mm且无溃疡的黏膜内胃癌，则表明可通过EM进行根治性切除。
