BACKGROUND: The objective of this study was to evaluate the accuracy of the intraoperative assessment of early gastric cancer (EGC) and lymph node status. METHODS: A total of 280 patients underwent gastrectomy for primary gastric cancer at the Department of Surgery, Yokohama City Kowan Hospital, from 1994 to 2002. Of these 280 patients, 140 were diagnosed as having EGC during surgery (sT1), while the rest were diagnosed with advanced disease (sT2-T4). Of the former 140 patients, 136 patients, who underwent curative resection with D1 or D2 lymphadenectomy, were further investigated for the assessment of lymph node status. RESULTS: The sensitivity, specificity, and accuracy of the surgical diagnosis of EGC were 96.4% (135 of 140), 90.0% (126 of 140), and 93.2% (261 of 280), respectively, while these values for the assessment of lymph node metastases were 55.6% (5 of 9), 94.5% (120 of 127), and 91.9% (125 of 136), respectively. In a further analysis in which patients with tumors of macroscopically depressed type and undifferentiated histology were excluded, all patients staged as sT1sN0 had no lymph node metastases pathologically. CONCLUSION: Although the depth of tumor invasion can be correctly assessed intraoperatively, it is difficult to be precise regarding the presence of nodal metastases. One practical solution to this problem might be to employ limited surgery for those patients with macroscopically elevated and histologically differentiated tumors.
BACKGROUND: The objective of this study was to evaluate the accuracy of the intraoperative assessment of early gastric cancer (EGC) and lymph node status. METHODS: A total of 280 patients underwent gastrectomy for primary gastric cancer at the Department of Surgery, Yokohama City Kowan Hospital, from 1994 to 2002. Of these 280 patients, 140 were diagnosed as having EGC during surgery (sT1), while the rest were diagnosed with advanced disease (sT2-T4). Of the former 140 patients, 136 patients, who underwent curative resection with D1 or D2 lymphadenectomy, were further investigated for the assessment of lymph node status. RESULTS: The sensitivity, specificity, and accuracy of the surgical diagnosis of EGC were 96.4% (135 of 140), 90.0% (126 of 140), and 93.2% (261 of 280), respectively, while these values for the assessment of lymph node metastases were 55.6% (5 of 9), 94.5% (120 of 127), and 91.9% (125 of 136), respectively. In a further analysis in which patients with tumors of macroscopically depressed type and undifferentiated histology were excluded, all patients staged as sT1sN0 had no lymph node metastases pathologically. CONCLUSION: Although the depth of tumor invasion can be correctly assessed intraoperatively, it is difficult to be precise regarding the presence of nodal metastases. One practical solution to this problem might be to employ limited surgery for those patients with macroscopically elevated and histologically differentiated tumors.