Korean J Gastroenterol.
1998 Jul;32(1):45-54.
Treatment Strategy for Early Gastric Cancer
Abstract
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BACKGROUND AND AIMS: The 5-year survival rate for early gastric cancer (EGC) now exceeds 90% and thus, EGC is now recognized as a curable malignancy. Additionally, It has been proved that some of EGC are free from lymph node metastasis, and so its treatment is less extensive. The present retrospective study was undataken to investigate the incidence of nodal involvement and its relation with the various clinicopathologic findings and establish the treatment strategy in EGC.
METHODS
Data of 345 patients with EGC who underwent gastrectomy during the period 1983-1996 at the department of surgery, Karea University College of Medicine, were analyzed.
RESULTS
The 5-year survival rate of all patients was 94.7%: 95.3% in mucosal (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. On the Other hand, M cancer showed no significant difference in both cases. Nodal involvement was shown in 49 patients (14.2%): 12 patients with M cancer (12/183, 6.6%) and 37 patients with SM cancer (37/162, 22.8%). Two cases less than 10 mm in diameter even in M cancer had lymph node involvement. There was no metastasis in protruded lesions less than 20 mm in diameter, well-differentiated lesions less than 10 mm and mucosal lesions with well- differentiated type.
CONCLUSIONS
The standard gastrectomy is necessary since EGC metastasize to regional lymph nodes at the rate of 14.2%. Tumors with maximum dimension of 10 mm or less, gross appearance of protruded type, differentiated histologic type, and invasion to the mucosa are less likely to be associated with lymph node metastasis and thus, are appropriate for less extensive treatment.
