A Clinical Analysis of Recurrence and Lymphatic Metastasis in Early Gastric Cancer

ABSTRACT

BACKGROUND: Among all gastric cancers, the most frequent malignant tumor in Korea, the proportion of early gastric cancer is increasing. This increase is bringing about controversy on the necessity of gastrectomy with extensive lymph node dissection for treatment. METHODS: Of 923 gastric cancer cases operated on at EulJi Medical Hospital from Jan. 1988 to Dec. 1996, we observed retrospectively 198 cases diagnosed as early gastric cancer on pathological biopsies. We performed this study in order to analyze the prognostic factors affecting recurrence and survival rate and to determine which characteristic of early gastric cancer influences lymph node metastasis. RESULTS: The rate of lymph node metastasis of early gastric cancer was 9.5% and it was revealed that depth of tumor invasion (p2 89.6%) and lymph node metastasis (n 96.3%, n 88.9%). CONCLUSIONS: Lymph mode metastasis is the most influential factor in the survival rate and the recurrence rate of early gastric cancer. We conclude that limited surgery is a reasonable treatment for differentiated mucosal cancers less than 5 cm and selectively for submucosal cancers less than 2 cm with elevation, which have the least possibility of recurrence and lymph node metastasis. However, a gas-trectomy with extensive regional lymph node dissection is still considered to be essential for either submucosal cancer with a depression or the submucosal cancer measuring more than 2 cm in size with elevation since recurrence and lymph node metastasis were frequently seen with these variants.