Assessing the suitability of gastric carcinoma for limited resection: endoscopic prediction of lymph node metastases.

Some early gastric carcinomas are free of lymph node involvement; however, the pathosis of these carcinomas is neither well understood nor reflected in the choice of less extensive treatment. We investigated the relation of nodal involvement to pathologic findings of the resected specimens. We present promising standards for predicting the nodal status of early gastric carcinomas, contributing to the indication for limited surgery. The relation of lymph node metastasis to tumor size, infiltration depth, macroscopic appearance, and histologic type of early gastric carcinomas were investigated in 1470 patients with a single primary early gastric carcinoma. Of these carcinomas, 763 were limited to the mucosa (mucosal carcinoma) and 707 to the submucosa (submucosal carcinoma). The overall incidence of lymph node metastasis was 9.0%: 2.1% in mucosal carcinomas and 16.5% in submucosal ones, with a significant (p < 0.001) difference of nodal involvement between the two. The macroscopically elevated or compound-type carcinomas 10 mm or less in diameter were all node-negative, whereas some depressed-type carcinomas were node-positive. The incidence of undifferentiated carcinomas increased with tumor diameter, irrespective of whether they were mucosal or submucosal carcinomas, and they were significantly more node-positive than were differentiated carcinomas: p < 0.001 for mucosal carcinomas and p < 0.05 for submucosal ones. The carcinomas satisfying the following criteria are node-negative and eligible for limited surgery: (1) mucosal carcinoma; (2) elevated lesion < 10 mm in diameter; (3) differentiated adenocarcinoma; and (4) no ulcer or ulcer scar. The other carcinomas are potentially node-positive and standard surgery is recommended.