General pattern of lymph node metastasis in early gastric carcinoma.

A reliable method for recognizing lymph node metastasis is indispensable for the attending physician to recommend less extensive treatment for early gastric carcinoma. Here we review 1137 consecutive patients with a single primary lesion, and the incidence and distribution of nodal involvement were investigated for correlations with pathologic findings. The overall incidence of metastasis was 9.5%: 2.6% for mucosal and 16.5% for submucosal carcinomas, a significant difference. The occurrence of metastasis was highest for lesions of the macroscopically mixed type, microscopically diffuse type, and large size. The involved nodes were most frequently found in the perigastric nodes along the lesser and greater curvatures, and it was well correlated with the tumor location, macroscopically depressed/mixed type, cancer depth, and histology. The diffuse-type carcinomas were most likely to metastasize to distant nodes. The distribution of involved nodes for early gastric carcinoma was similar to that for advanced carcinoma, as previously been reported. The submucosal carcinomas in this series had no indications for less extensive treatment, such as endoscopic or laparoscopic limited surgery. These carcinomas should be subject to standard surgery with gastrectomy and combined dissection of lymph nodes, especially node stations 1 and 3 to 8. The mucosal carcinomas sometimes involved the perigastric nodes, and such cases underwent gastrectomy and lymphadenectomy of node stations 1 and 3 to 7. Mucosal carcinomas 10 mm or less in size were negative for lymph node metastasis and were considered appropriate for less extensive treatment.