Clinicopathologic Characteristics of and Surgical Strategy for Patients with Submucosal Gastric Carcinomas

PURPOSE: Early gastric cancer (EGC) has an excellent prognosis compared to advanced gastric cancer. The 5-year survival rate for EGC now exceeds 90%, and EGC is recognized as a curable malignancy. The important prognostic factor in EGC is the status of lymph-node metastasis. Despite conserving surgery being suggested for EGC at present, it is of vital importance to select a surgical method appropriate to each individual case. This retrospective study was undertaken to clarify clinicopathologic features and factors related to lymph-node metastasis in submucosal gastric cancer in order to determine an appropriate therapy. MATERIALS AND METHODS: This study analyzed the clinicopathologic features for 279 patients with a submucosal gastric carcinoma (Group I) and compared with those of patients with mucosal (Group II) or muscularis proprial gastric carcinoma (Group III). All patients were operated on from 1981 to 1999 at Chonnam University Hospital. There were no statistically significant differences among the groups with respect to age, gender, tumor location, hepatic metastasis, or peritoneal dissemination. RESULTS: Positive lymph node metastasis was found in 47 (16.8%) of the 279 patients with a submucosal gastric carcinoma. The incidence of lymph-node metastasis was significantly higher in patients with a submucosal gastric carcinoma than in patients with a mucosal gastric carcinoma (16.8% vs. 3.9%; P<0.01). Therefore, depth of invasion was a significant factor affecting in lymph-node metastasis. The 5-year survival rates were 88.6% for patients in Group I, 95.2% for patients in Group II, and 72.7% for patients in Group III (P<0.01 for Group I vs. Group II; Group I vs. Group III). In patients with a submucosal gastric carcinoma, the survival rate with positive lymph nodes was significantly poorer than that of patients without lymph-node metastasis (87.3% vs. 94.2%; P<0.01). CONCLUSION: Gastrectomy with D2 lymph node dissection is an appropriate operative procedure for patients with a submucosal gastric carcinoma.

Clinicopathologic Characteristics of and Surgical Strategy for Patients with Submucosal Gastric Carcinomas

PURPOSE: Early gastric cancer (EGC) has an excellent prognosis compared to advanced gastric cancer. The 5-year survival rate for EGC now exceeds 90%, and EGC is recognized as a curable malignancy. The important prognostic factor in EGC is the status of lymph-node metastasis. Despite conserving surgery being suggested for EGC at present, it is of vital importance to select a surgical method appropriate to each individual case. This retrospective study was undertaken to clarify clinicopathologic features and factors related to lymph-node metastasis in submucosal gastric cancer in order to determine an appropriate therapy. MATERIALS AND METHODS: This study analyzed the clinicopathologic features for 279 patients with a submucosal gastric carcinoma (Group I) and compared with those of patients with mucosal (Group II) or muscularis proprial gastric carcinoma (Group III). All patients were operated on from 1981 to 1999 at Chonnam University Hospital. There were no statistically significant differences among the groups with respect to age, gender, tumor location, hepatic metastasis, or peritoneal dissemination. RESULTS: Positive lymph node metastasis was found in 47 (16.8%) of the 279 patients with a submucosal gastric carcinoma. The incidence of lymph-node metastasis was significantly higher in patients with a submucosal gastric carcinoma than in patients with a mucosal gastric carcinoma (16.8% vs. 3.9%; P<0.01). Therefore, depth of invasion was a significant factor affecting in lymph-node metastasis. The 5-year survival rates were 88.6% for patients in Group I, 95.2% for patients in Group II, and 72.7% for patients in Group III (P<0.01 for Group I vs. Group II; Group I vs. Group III). In patients with a submucosal gastric carcinoma, the survival rate with positive lymph nodes was significantly poorer than that of patients without lymph-node metastasis (87.3% vs. 94.2%; P<0.01). CONCLUSION: Gastrectomy with D2 lymph node dissection is an appropriate operative procedure for patients with a submucosal gastric carcinoma.

Predictors of Lymph Node Metastasis in Submucosal Gastric Carcinomas

PURPOSE: Submucosal gastric carcinomas metastasize to lymph nodes more often than the intramucosal gastric carcinomas. The objectives of this study are to clarify the characteristics of submucosal gastric carcinomas, especially in reference to the status of lymph node metastasis, and to explore the possibility of a minimally invasive operation. MATERIALS AND METHODS: The clinicopathologic features of 88 patients with submucosal gastric carcinoma, all of whom were treated with a D(2)(+)alpha gastrectomy between January 1994 and December 1999, were examined retrospectively with respect to the status of lymph nodes. The size, depth of submucosal invasion, histologic differentiation, location, and macroscopic finding of the tumor were investigated in association with the presence or the absence of lymph node metastasis. RESULTS: Among the 88 patients, 15 (17.05%) had lymph node metastasis, and the status of metastasis was significantly correlated with tumor size and depth of submucosal invasion. The frequency of metastasis was 0% (0/7) of up to 1.0cm and 18.5% (15/81) over 1.0 cm in size (P=0.034) and 6.1% (2/33) of up to 1.0 mm and 23.6% (13/55) over 1.0 mm in depth of submucosal invasion (P=0.042). CONCLUSION: The tumor size and depth of submucosal invasion are useful indicators of lymph node metastasis in submucosal gastric carcinoma. A minimally invasive operation can be applied for submucosal gastric carcinoma up to 1.0 cm in size. Further studies are needed to limited surgery for depth of submucosal invasion.

Predictors of Lymph Node Metastasis in Submucosal Gastric Carcinomas

PURPOSE: Submucosal gastric carcinomas metastasize to lymph nodes more often than the intramucosal gastric carcinomas. The objectives of this study are to clarify the characteristics of submucosal gastric carcinomas, especially in reference to the status of lymph node metastasis, and to explore the possibility of a minimally invasive operation. MATENRIALS AND METHODS: The clinicopathologic features of 88 patients with submucosal gastric carcinoma, all of whom were treated with a D2+alpha gastrectomy between January 1994 and December 1999, were examined retrospectively with respect to the status of lymph nodes. The size, depth of submucosal invasion, histologic differentiation, location, and macroscopic finding of the tumor were investigated in association with the presence or the absence of lymph node metastasis. RESULTS: Among the 88 patients, 15 (17.05%) had lymph node metastasis, and the status of metastasis was significantly correlated with tumor size and depth of submucosal invasion. The frequency of metastasis was 0% (0/7) of up to 1.0 cm and 18.5% (15/81) over 1.0 cm in size (p=0.034) and 6.1% (2/33) of up to 1.0mm and 23.6% (13/55) over 1.0 mm in depth of submucosal invasion (p=0.042). CONCLUSION: The tumor size and depth of submucosal invasion are useful indicators of lymph node metastasis in submucosal gastric carcinoma. A minimally invasive op-eration can be applied for submucosal gastric carcinoma up to 1.0 cm in size Further studies are needed to limited surgery for depth of submucosal invasion.