A Comparative Retrospective Study of Mucosal and Submucosal Cancer in Early Gastric Cancer

ABSTRACT

BACKGROUND: The 5-year survival rate for early gastric cancer (EGC) now exceeds 90% and EGC is now recognized as a curable malignancy. The less extensive treatment has attracted interest. It is of vital importance to select a surgical method appropriate to each individual case. A retrospective study was undertaken to compare clinicopathologic features between mucosal (M) and submucosal (SM) cancers and to evaluate treatment modality for EGC. METHODS: We analyzed clinicopathologic data on 345 surgically treated patients with early gastric cancer between September 1983 and December 1996 at the Department of Surgery, Korea University College of Medicine 183 patients with mucosal cancer and 162 patients with submucosal cancer. RESULTS: The rate of detection of EGC has been increasing as high as 25% since 1990. There were significant differences between M and SM cancers with regard to the location of the tumor, lymph node metastasis and histologic type. The SM cancer had lower 1/3 in location, more lymph node metastasis and more differentiated than M cancer. Nodal involvement was evident in 49 patients (14.2%) 6.6% (12/183) with M cancer and 22.8% (37/162) with SM lesions. The 5-year survival rate of all patients was 94.7% 95.3% in M cancer and 94.0% in submucosal SM cancer. The 5-year survival rates for SM cancer were 96.1% in node-negative cases and 86.3% in node-positive cases with significance and M cancer had no survival difference. CONCLUSIONS: As early gastric cancer can be cured by surgery, 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.