A clinicopathological analysis of early gastric cancer: retrospective study with special reference to lymph node metastasis.

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.