Study on lymph node metastasis in 292 patients with early gastric cancer / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the status of lymph node metastasis (LNM) and reasonable procedure in early gastric cancer (EGC).</p><p><b>METHODS</b>Two hundred and ninety-two patients with histologically proven mucosal or submucosal gastric cancer who underwent gastrectomy/lymphadenectomy were included in this study. The numbers of total dissected lymph node were all above 15 in all patients. The clinical characteristics, pathologic features, and LNM were assessed by univariate and multivariate analysis.</p><p><b>RESULTS</b>LNM were observed in 43 of 292 cases (14.7%), and 6.4% in mucosal lesions and 22.4% in submucosal lesions. The LNM was identified in 12.7% at the first level, 7.2% at the second level and 0.34% at the third level. The LNM frequency was found in the 6, 3, 4, 1, 5 lymph node (from high to low) consequently at the first level and the 7, 8a lymph node at the second level. The EGC with nodal involvement and the tumors < 2.0 cm in diameter were all depressed type. The diameter of elevated type with LNM was no less than 3.0 cm in this series. The depth of invasion and lymphatic vessel involvement were independent influencing factors in LNM on multivariate analysis (P<0.05).</p><p><b>CONCLUSIONS</b>Less extensive surgery might be considered for the elevated type EGC, and tumors <or= 2.0 cm in diameter and mucosal lesions. Gastrectomy with D1 plus No.7, 8a lymphadenectomy might be carried out in the depressed type/<or= 3.0 cm in diameter, or in the elevated type/> 3.0 cm in diameter. With respect to the depressed type EGC/tumors > 3.0 cm in diameter, gastrectomy with D2 lymphadenectomy is proper.</p>