BACKGROUND: Gastrectomy with D2 lymph node dissection is the standard treatment for locally advanced gastric cancer in Japan. However, in patients with a preoperative diagnosis of early gastric cancer, gastrectomy with limited lymph node dissection is generally selected as a treatment option, despite a pathological diagnosis of advanced gastric cancer. The aim of the present study was to clarify the clinicopathological characteristics and feasibility of limited lymph node dissection in patients with clinically early, but pathologically advanced, gastric cancer. MATERIALS AND METHODS: Clinicopathological characteristics, including the incidence and susceptible sites for lymph node metastasis, were investigated in 1528 patients with a final diagnosis of T2 gastric cancer treated at the Cancer Institute Hospital. For these patients, the results were compared between two groups including 266 patients preoperatively diagnosed as early T1 gastric cancer (EpT2) and 1262 patients preoperative diagnosed as locally advanced gastric cancer (ApT2). RESULTS: The pathological stage was lower (P < .001), and the 5-year survival rate was better (91.0% vs. 73.1%, P < .001) for the EpT2 group compared with the ApT2 group. Moreover, the N stage was smaller in the EpT2 group than in the ApT2 group, and the extension of lymph node metastasis was limited in 261 out of 266 patients (98%). CONCLUSION: Patients with EpT2 gastric cancer had a better 5-year survival rate than the patients in the ApT2 group. Gastrectomy with limited lymph node dissection could be indicated for patients with EpT2 gastric cancer unless intraoperative finding indicated obvious lymph node metastasis.
BACKGROUND: Gastrectomy with D2 lymph node dissection is the standard treatment for locally advanced gastric cancer in Japan. However, in patients with a preoperative diagnosis of early gastric cancer, gastrectomy with limited lymph node dissection is generally selected as a treatment option, despite a pathological diagnosis of advanced gastric cancer. The aim of the present study was to clarify the clinicopathological characteristics and feasibility of limited lymph node dissection in patients with clinically early, but pathologically advanced, gastric cancer. MATERIALS AND METHODS: Clinicopathological characteristics, including the incidence and susceptible sites for lymph node metastasis, were investigated in 1528 patients with a final diagnosis of T2 gastric cancer treated at the Cancer Institute Hospital. For these patients, the results were compared between two groups including 266 patients preoperatively diagnosed as early T1 gastric cancer (EpT2) and 1262 patients preoperative diagnosed as locally advanced gastric cancer (ApT2). RESULTS: The pathological stage was lower (P < .001), and the 5-year survival rate was better (91.0% vs. 73.1%, P < .001) for the EpT2 group compared with the ApT2 group. Moreover, the N stage was smaller in the EpT2 group than in the ApT2 group, and the extension of lymph node metastasis was limited in 261 out of 266 patients (98%). CONCLUSION:Patients with EpT2 gastric cancer had a better 5-year survival rate than the patients in the ApT2 group. Gastrectomy with limited lymph node dissection could be indicated for patients with EpT2 gastric cancer unless intraoperative finding indicated obvious lymph node metastasis.
Authors: Raffaele Pugliese; Dario Maggioni; Fabio Sansonna; Andrea Costanzi; Giovanni Carlo Ferrari; Stefano Di Lernia; Carmelo Magistro; Paolo De Martini; Francesco Pugliese Journal: Surg Endosc Date: 2010-04-23 Impact factor: 4.584