Predictors of Lymph Node Metastasis in Submucosal Gastric Carcinomas

ABSTRACT

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.