Indications for Limited Surgery for Early Gastric Cancer: Analysis of Patients with Lymph Node Metastasis

To evaluate the possibility of limited surgery of early gastric cancer, 500 patients with solitary early gastric cancer were analyzed. Lymph node metastasis was found in 2 (0.8 %) of 260 patients with mucosal cancer, and 45 (18.8 %) of 240 patients with submucosal cancer. In early gastric cancer with lymph node metastasis, the primary tumor tended to be undifferentiated and large, especially in tumors of more than 2 cm in diameter. Tumors located on the greater curvature had a higher rate of lymph node metastasis than did tumors on the lesser curvature or the anterior wall.On the basis of the results of this series, we propose that the decision of limited surgery for early gastric cancer should depend mainly on the depth of cancerous invasion, tumor diameter, and histologic type. First, tumors of less than 1 cm in diameter without ulcer and differentiated mucosal cancer 2 cm or less in diameter without ulcer can be treated with endoscopic surgery. If cancerous invasion is found in the submucosa or lymphatic vessels of the resected specimen, limited surgery should be performed after endoscopic surgely. Second, undifferentiated mucosal cancers 1 to 2 cm in diameter, submucosal tumors 1 to 2 cm in diameter, and mucosal tumors of more than 2 cm in diameter can be treated with limited surgery. Third, gastrectomy with D2 lymphandectomy is still indicated for submucosal cancer, if the diameter is greater than 2 cm.