Surgical Results of Early Gastric Cancer and Proposing a Treatment Strategy

Background Prognosis for patients with early gastric cancer after surgical resection is excellent. The 5-year or even 10-year survival is more than 90%. In the present study, we investigated the result of treating early gastric cancer surgically in our hospital, with special reference to the risk factor(s) for tumor recurrence and the relationship between age and survival. Patients and Methods From January 1988 to December 2002, a total of 479 patients with early gastric cancer underwent resection by our surgeons. Results of preoperative studies, operative findings, histopathology and postoperative follow-up were recorded respectively, and the postoperative disease-related survival, overall survival, tumor recurrence and recurrent patterns were analyzed. The clinicopathological factors were also analyzed to identify the risk factor(s) related to tumor recurrence. Results Older patients (>75 years old) had a poorer overall survival than younger patients. However, the disease-related survival was not significantly different between the two. Recurrence was observed in 21 patients, the most important factor of which was lymph node status. Lymph node metastases occurred in 54 patients (11.3%)—coming from mucosal tumors in 12 patients (4.4%) and from submucosal tumors in 42 (20.3%). When the size of the mucosal tumor was smaller than 1 cm, no lymph node metastasis was found in our patients. Conclusions The most important risk factor of recurrence in early gastric cancer is lymph node status. Given the low probability of lymph node metastasis and recurrence in tumors less than 1 cm in diameter limited to the mucosa, more limited surgery maybe appropriate in these carefully selected instances.     

Predictive factors for lymph node metastasis in early gastric cancer with submucosal invasion: analysis of a single institutional experience

OBJECTIVE: An accurate assessment of a potential lymph node metastasis is an important issue for the appropriate treatment of early gastric cancer. Minimizing the amount of invasive procedures used in cancer treatment is critical for improving the patient's quality of life. Therefore, this study analyzed the predictive risk factors for a lymph node metastasis in early gastric cancer with a submucosal invasion. METHODS: The data from 1043 patients surgically treated for early gastric cancer with submucosal invasion between 2002 and 2005 were reviewed retrospectively. The patients were divided into 3 layers according to their depth: SM1, SM2, and SM3. The clinicopathological variables predicting a lymph node metastasis were evaluated. RESULTS: A lymph node metastasis was observed in 19.4% of patients. The tumor size, histologic type, Lauren classification, tumor depth, and perineural invasion showed a positive correlation with the rate of lymph node metastasis and N category by univariate analysis. Multivariate analyses revealed the tumor size (>or=2 cm) and lymphatic involvement to be significantly and independently related to lymph node metastasis. The presence of lymphatic involvement was the strongest predictive factor for a lymph node metastasis, being observed in 43.8% of cases in which a lymph node metastasis had been revealed. No lymph node metastasis was observed in the 12 cases with no lymphatic involvement, SM1 invasion, and tumor size <1 cm. CONCLUSIONS: Lymphatic involvement and tumor size are independent risk factors for a lymph node metastasis in early gastric cancer with submucosal invasion. Minimal invasive treatment, such as endoscopic mucosal resection, may be possible in highly selective submucosal cancers with no lymphatic involvement, SM1 invasion, and tumor size <1 cm.     

Surgical Indication for Non-curative Endoscopic Resection in Early Gastric Cancer

Background Endoscopic resection (ER) is an effective treatment for early gastric cancer (EGC) without lymph node metastasis. However, after ER additional surgery may be needed to manage the risks presented by residual cancer or lymph node metastasis. Methods ER was performed on 344 gastric adenocarcinomas between November 2001 and April 2006 at the Korean National Cancer Center under the strict pre-procedural indication. The authors performed operations in 43 patients due to: residual mucosal cancer, a mucosal cancer larger than 3 cm, or a submucosal cancer regardless of size or margin involvement. ER and surgical specimens were reviewed and analyzed for residual cancer and lymph node metastasis. Results Based on examinations of ER specimens, cancer was confined to the mucosal layer in 15 patients (34.9%) and invaded the submucosal layer in 28 patients (65.1%). Surgical specimens showed residual cancer in 17 patients (39.5%) and lymph node metastasis in four (9.3%). Neither residual cancer nor lymph node metastasis was found in patients with less than 500 μm submucosal invasion without margin involvement in ER specimens. In three of four patients with lymph node metastasis, the depth of submucosal invasion was 500 μm or more; the remaining patient had a 4-cm-sized differentiated mucosal cancer. Conclusions When a pathologic evaluation of an ER specimen reveals more than 500 μm of submucosal invasion or a mucosal cancer of larger than 3 cm, surgery should be considered due to the risk of lymph node metastasis.     

Superficially spreading cancer of the stomach

Background Superficially spreading cancer (SSC) of the stomach is rare and extends widely along the mucosa or submucosa of the stomach. This study was conducted to clarify the clinicopathologic characteristics and prognosis of patients with SSC. Methods SSC was defined as a tumor invading the mucosa or submucosa and measuring ≥5 cm in size. The clinicopathologic findings and outcomes of 36 patients with SSC were compared with those of 300 patients with early gastric cancer (EGC) measuring ≤5 cm and 271 with advanced gastric cancer measuring ≥5 cm. Results SSC was significantly different from ordinary EGC in tumor size, frequency of lymph node metastasis, lymphatic invasion, venous invasion, and stage II, III and IV disease. The frequency of serosal invasion, lymph node metastasis, and lymphatic and venous invasions in cases of SSC was significantly lower than with advanced gastric cancer. Although tumor size of SSC evaluated before operation was smaller than that on the resected specimen, the 10-year survival rate was not different between SSC and ordinary EGC. Conclusions SSC was characterized by high frequency of lymph node metastasis and preoperative underestimation of tumor size. SSC should be treated by a gastrectomy and lymphadenectomy with sufficient resection margin.     

Predictive factors for lymph node metastasis in early gastric cancer with signet ring cell histology and their impact on the surgical strategy: analysis of single institutional experience

Background

The prognosis of early gastric cancer (EGC) with signet ring cell histology is more favorable than other undifferentiated gastric adenocarcinomas. An accurate assessment of potential lymph node metastasis is important for the appropriate treatment of EGC with signet ring cell histology. Therefore, this study analyzed the predictive factors associated with lymph node metastasis in patients with this type of EGC.

Methods

A total of 136 EGC with signet ring cell histology patients who underwent D2 radical gastrectomy were reviewed in this study. The clinicopathologic features were analyzed to identify predictive factors for lymph node metastasis.

Results

The overall rate of lymph node metastasis in EGC with signet ring cell histology was 10.3%. Using a univariate analysis, the risk factors for lymph node metastasis were identified as the tumor size, depth of tumor invasion, and lymphovascular invasion. The multivariate analysis revealed that tumor size >2 cm, submucosal invasion, and lymphovascular invasion were independent risk factors of lymph node metastasis (P < 0.05).

Conclusions

The risk of lymph node metastasis of EGC with signet ring cell histology was high in those with tumor sizes ≥2 cm, submucosal tumors, and lymphovascular invasion. A minimally invasive treatment, such as endoscopic resection, might be possible in highly selective cases of EGC with signet ring cell histology with intramucosal invasion, tumor size <2 cm, and no lymphovascular invasion.     

Is palliative resection necessary for gastric carcinoma patients?

Background and aims The benefit of palliative resection for gastric carcinoma patients remains controversial. We thus evaluated the survival benefit of palliative resection in advanced gastric carcinoma patients. Materials and methods We reviewed the hospital records of 466 gastric carcinoma patients who had palliative resection and compared the clinicopathologic findings to those of patients who underwent a bypass or exploration from 1986 to 2000. Results Cox’s proportional hazard regression model revealed only one independent statistically significant prognostic parameter, the presence of peritoneal dissemination (risk ratio, 0.739; 95% confidence interval, 0.564–0.967; P < 0.05). The 5-year survival rate of patients who had palliative resection was higher than that of patients who did not (7.03 vs 0%, P < 0.001). When the 5-year survival rates of patients with peritoneal dissemination were examined, the rate was higher for those who underwent resection (4.43 vs 0%, P < 0.001). Conclusion The results highlight the improved survivorship of gastric carcinoma patients with palliative resection compared to those who did not undergo the procedure. Although curative resection is not possible in this group of patients, we recommend performing resection aimed at palliation.     

Prognostic significance of the number of metastatic lymph nodes in early gastric cancer

BACKGROUND: The prognostic value of the number of metastatic lymph nodes in early gastric cancer has not been evaluated much, although the significance of metastatic lymph nodes is defined by the location of positive nodes, according to the JRSGC for gastric cancer. METHODS: The postoperative courses of 305 early gastric cancer patients who had undergone D2-extended lymphadenectomy were followed up for a median of 108 months to evaluate the significance of the number of metastatic lymph nodes on recurrence of the disease. RESULTS: Recurrence of gastric cancer was more frequently observed in submucosal cancer than in mucosal cancer. All patients but one who revealed recurrence had nodal metastasis at the time of surgery. In cases with 1-3 metastatic lymph nodes, no patient had revealed any sign of recurrence; however, in cases with 4 or more metastatic lymph nodes, 6 of 7 patients died of recurrent disease. There were 3 cases of bone metastases, 2 of peritoneal dissemination, and 1 each of both recurrent diseases. CONCLUSIONS: These data suggest that in n-positive cases, in which there are 4 or more metastatic lymph nodes, there is a high probability of recurrence of early gastric cancer, and especially of hematogenic metastasis.     

早期远端胃印戒细胞癌淋巴结转移的危险因素分析及外科手术指征探讨

目的研究早期远端胃印戒细胞癌淋巴结转移的危险因素,进一步分析其外科手术指征。方法回顾性分析2013年3月至2018年11月期间在苏州大学附属第一医院普外科接受外科根治手术且术后病理学检查证实为远端胃印戒细胞癌的91例早期胃癌患者的临床资料,收集患者的性别、年龄、肿瘤最大径、病灶数量、浸润深度、肿瘤大体外观、脉管癌栓、合并溃疡等数据,探索发生淋巴结转移的危险因素,进一步分析外科手术指征。结果91例早期远端胃印戒细胞癌均接受了外科根治性手术,其中淋巴结转移10例。单因素分析结果显示,肿瘤最大径(χ^2=5.631,P=0.025)、浸润深度(χ^2=4.389,P=0.016)、病灶数量(χ^2=5.615,P=0.023)及脉管癌栓(χ^2=22.500,P=0.001)均与早期远端胃印戒细胞癌的淋巴结转移有关。多因素分析结果显示,肿瘤最大径(OR=3.675,P=0.012)、浸润深度(OR=3.886,P=0.015)及脉管癌栓(OR=8.711,P<0.001)是早期远端胃印戒细胞癌发生淋巴结转移的影响因素,肿瘤最大径≥2 cm、浸润至黏膜下层及有脉管癌栓的患者有更高的淋巴结转移率。结论肿瘤最大径≥2 cm、浸润至黏膜下层及存在脉管癌栓的早期远端胃印戒细胞癌患者有更高的淋巴结转移风险;满足肿瘤最大径≥2 cm和存在脉管癌栓中任何1项条件者均可能需接受外科根治性手术。     

Peritoneal Carcinoembryonic Antigen Level for Predicting Locoregional and Distant Spread of Gastric Cancer

Purpose Peritoneal recurrence is not an uncommon cause of death after surgery for gastric cancer, even after surgery with curative intent. This indicates that there is undetected residual disease in the peritoneal cavity. We conducted this study to determine the value of peritoneal and serum carcinoembryonic antigen (CEA) levels and peritoneal washing cytology in predicting the locoregional and distant spread of gastric cancer. Methods We prospectively evaluated 70 consecutive patients with gastric cancer by measuring peritoneal CEA (pCEA) and serum CEA (sCEA) levels and peritoneal washing cytology results, and studying their effect on the histopathologic properties. The effect of the pCEA level on disease-free survival (DFS) and overall survival (OS) was also evaluated in patients treated with curative intent. Results Twenty-one (30%) patients had sCEA levels >10 ng/ml, whereas 25 patients (35.7%) had pCEA levels >10 ng/g protein and 26 patients (37.1%) had positive cytology. The pCEA levels were significantly higher in patients with hepatic metastases (P = 0.034), or serosal (P = 0.028), and peritoneal (P = 0.026) involvement, whereas the sCEA levels were significantly higher only in patients with hepatic metastases (P = 0.04). Similarly, positive cytology was mainly detected in patients with hepatic metastases (P = 0.004). The pCEA levels significantly affected DFS (P = 0.002) and OS (P = 0.01) in 34 patients treated with curative intent. Conclusion Since pCEA levels are more useful for predicting locoregional recurrence, their measurement during surgery may help plan the most appropriate surgical strategy and adjuvant therapy.     

Correlation between serum immunosuppressive substance and clinico-pathological findings in patients with gastric carcinoma

Serum levels of immunosuppressive substance (IS) were determined in 99 patients with gastric cancer and in 32 healthy individuals. The serum IS levels in the patients (769.6±314.8 μg/ml) were significantly higher than those in the healthy individuals (549.7±104.7 μg/ml). A multivariate analysis on the correlation between serum IS levels and clinicopathological findings in the patients disclosed that there was a close correlation between the serum IS levels and the depth of invasion, in particular, the prognostic serosal invasion, metastasis to the distal lymph nodes and peritoneal dissemination. There was, however, no correlation between the serum IS level and hepatic metastasis. Serum IS levels were higher in patients with well-differentiated adenocarcinoma than in those with poorly differentiated adenocarcinoma or signet ring cell carcinoma. A serum IS level higher than 1000 μg/ml indicates the possibility that the tumor is only palliatively resectable because of involvement of the distal lymph nodes or peritoneal dissemination.     

Carcinomatous Lymphatic Invasion in Early Gastric Cancer Invading Into the Submucosa

Background: Lymphatic invasion is a risk factor for lymph node metastases in patients with gastric cancer. No studies have been reported, however, on the correlation between lymphatic invasion and lymph node metastasis in early gastric cancer invading into the submucosa.Methods: We performed a retrospective analysis of lymphatic invasion in 170 patients with early gastric cancer invading into the submucosa.Results: Lymphatic invasion was found in 76 patients. Lymphatic invasion correlated significantly with the presence of lymph node metastasis and vascular invasion (P < .05) and with the degree of cancerous submucosal involvement (P < .05). The presence of lymph node metastasis also correlated with the grade of submucosal invasion and lymphatic invasion. The 5-year survival of patients with lymphatic invasion was poorer than that of patients without lymphatic invasion (P < .05). Node-negative patients had similar survival, regardless of the presence of lymphatic invasion. All patients with severe lymphatic invasion had sm3 invasion and lymph node metastases.Conclusion: Although lymphatic invasion is the first stage of lymph node metastasis, lymphatic invasion in itself does not have clinical importance except for severe invasion in early gastric cancer. It is possible to predict lymph node metastases from the combined evaluation of degree of lymphatic invasion and submucosal involvement of the tumor in patients with early gastric cancer invading into the submucosa.     

Tumor Diameter as a Prognostic Factor in Patients with Gastric Cancer

Background  The aim of this study was to evaluate the prognostic value of tumor diameter in gastric cancer. Methods  The study group comprised a series of 1215 patients who underwent curative gastrectomy. The appropriate tumor diameter cutoff value was determined. Prognostic factors were evaluated by univariate and multivariate analyses. Results  The tumor diameter cutoff value was 100 mm. Multivariate analysis showed that tumor site, macroscopic appearance, tumor diameter, depth of invasion, and presence of lymph node metastasis independently affected prognosis in all patients. Multivariate analysis of patients with larger tumors identified depth of invasion as an independent prognostic factor. A comparison between patients with smaller and larger tumors showed marked differences in the survival of those with stage II, IIIA, and IIIB tumors. A comparison of clinicopathological factors between stage II and III patients revealed that tumors occupying the entire stomach, ill-defined, undifferentiated, and serosa-penetrating tumors, and peritoneal metastases were far more frequent in patients with larger tumors. Conclusions  Tumor diameter in gastric cancer is a reliable prognostic factor that might be a candidate for use in the staging system. To improve outcomes for patients with tumors ≥100 mm in diameter, it is necessary to establish therapeutic strategies for peritoneal metastasis, particularly in stage II and III tumors.     

Prognostic Significance of Tumor Size in T3 Gastric Cancer

Background  Clinical significance of tumor size remains elusive in gastric cancer. The aim of this study was to evaluate the prognostic value of tumor size in T3 gastric cancer. Methods  A total of 273 patients with T3 gastric cancer who underwent curative D2 gastrectomy between 1996 and 2005 were evaluated. In terms of average value of tumor size, patients were divided into two groups according to tumor size: small-size group (SSG, tumor ≤6 cm) and large-size group (LSG, tumor >6 cm). The prognostic value of tumor size and the correlation between tumor size and other clinicopathologic factors were investigated. Results  LSG accounted for 34.8% in all patients. Tumor size was correlated with histological type, lymphatic invasion, venous invasion, and resection type. The prognosis of LSG patients was worse than that of SSG patients. Multivariate analysis showed that type of resection, status of lymph nodes, metastatic lymph node ratio, and tumor size were defined as independent prognostic factors for patients with T3 gastric cancer. A comparison between LSG patients and SSG patients showed differences in the survival of those with stage IIIB and IV disease. Conclusions  Tumor size is a simple and reliable prognostic factor for patients with T3 gastric cancer; it might be a candidate for the gastric cancer staging system.     

Clinicopathological features of gastric carcinoma in younger and middle-aged patients: A comparative study

Gastric carcinoma is relatively rare in patients under the age of 40. This study was undertaken to clarify the clinicopathological characteristics and surgical outcomes of gastric carcinoma in younger patients compared with those of middle-aged patients. The surgical results from 131 younger patients (aged ⩽40 years) and 918 middle-aged patients (aged 55–65 years) were compared retrospectively. Female gender, undifferentiated tumor type and lymphatic invasion were significantly more common in the younger patients. Survival time did not differ between the two groups. The depth of tumor invasion was the only prognostic factor in younger patients, whereas macroscopic appearance, tumor diameter, depth of invasion, lymph node metastasis, and venous invasion were all significant prognostic factors in middle-aged patients. Peritoneal recurrence was significantly more common in younger patients. A family history of gastric adenocarcinoma was observed in 25.9% of younger patients, but this did not affect survival outcomes. As depth of invasion affects prognosis independently, and peritoneal metastasis is the predominant pattern of recurrence, it is essential to establish an optimal prophylactic treatment for peritoneal metastasis to improve surgical outcomes in younger patients with advanced gastric cancer.     

晚期胃癌姑息性胃切除的临床价值

目的　比较晚期胃癌姑息性胃切除 (palliativegastrectomy ,PG)与非切除手术 (unresectableoperation ,UO)的临床病理及预后 ,探究姑息性胃切除治疗不能根治的晚期胃癌的临床价值。　方法共有 95例不能根治的晚期胃癌患者施行了手术 ,其中 6 4例行姑息性胃切除 ,31例行姑息性非切除手术 ,比较姑息性胃切除与非切除组的临床病理及预后。　结果　 2组患者年龄、性别构成比差异无显著性意义。瘤体较大、浸润度为T4 以及TNM分期较晚所占比例在UO组高于PG组 (P <0 0 1) ,腹膜播散、肝转移、淋巴结转移、肿瘤部位 2组差异无显著性意义 (P >0 0 5 )。PG组 1、2年生存率为48 1%、2 3 1% ,UO组 1年生存率为 13 5 % (P <0 0 1)。　结论　对于晚期不能根治的胃癌患者 ,即使存在有腹膜播散、肝转移、远处淋巴结转移、周围脏器侵犯等 ,姑息性胃切除可以改善其预后。     

Local Excision for ypT2 Rectal Cancer—Much Ado About Something

Background The role of local excision for pT2 distal rectal cancer has been challenged because of the observation of high rates of lymph node metastases and local failure. However, neoadjuvant chemoradiation therapy (CRT) has led to increased local disease control and significant tumor downstaging, possibly decreasing rates of lymph node metastases. In this setting, a possible role for local excision of ypT2 has been suggested. Methods A total of 401 patients with distal rectal cancer underwent neoadjuvant CRT. Tumor response assessment was performed after at least 8 weeks from CRT completion. One hundred and twelve patients with complete clinical response were not immediately operated on and were excluded from the study, and 289 patients with incomplete clinical response were managed by radical surgery. Patients with final pathological stage ypT2 were analyzed to determine the risk of unfavorable pathological features that could represent unacceptable risk for local failure after local excision. Results Eighty-eight (30%) patients had ypT2 rectal cancer. Final ypT status was not associated with pretreatment radiological staging (p = 0.62). ypT status was significantly associated with the risk of lymph node metastases, risk of perineural and vascular invasion, and recurrence (p = 0.001). Lymph node metastases were present in 19% of patients with ypT2 rectal cancer. The risk of lymph node metastases in ypT2 was associated with the presence of perineural invasion (47% vs 4%; p = <0.001), vascular invasion (59% vs 6%; p < 0.001), and decreased mean interval CRT surgery (12 vs 18 weeks; p < 0.001), but not with mean tumor size (3.2 vs 3.1 cm; p = 0.8). Disease-free and overall survival rates were significantly better for patients with ypT2N0 (p = 0.02 and 0.006, respectively). Fifty-five (63%) patients with ypT2 had at least one unfavorable pathological feature for local excision (lymph node metastases, vascular or perineural invasion, mucinous type or tumor size >3 cm). Conclusion Lymph node metastases were present in 19% of patients with ypT2 and were significantly associated with poor overall and disease-free survival rates. The risk of lymph node metastases could not be predicted by radiological staging or tumor size. Radical surgery should be considered the standard treatment option for ypT2 rectal cancer after CRT. Presented at the Plenary Session of the 48th Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, D.C., May 19–23, 2007.     

Lymph Node Status in Patients with Submucosal Gastric Cancer

Background The aim of this study was to clarify the lymph node status in patients with submucosal gastric cancer.Methods Between April 1994 and December 1999, 615 patients with histologically proven submucosal gastric cancer who underwent curative resection were included in this study. The results of the surgery and predictive factors for lymph node metastasis were evaluated by univariate and multivariate analyses. The accuracy of the predictive factors was assessed in a second population of a further 186 patients.Results Lymph node metastasis was observed in 119 patients (19.3%). Multivariate analysis showed that pathologic tumor diameter (≥20 mm) and lymphatic invasion were independent predictive factors for lymph node metastasis. The incidence of lymph node metastasis without these 2 predictive factors was 1.8% (2 of 113), and it was 51.2% (85 of 166) with the 2 predictive factors, 9.5% (14 of 148) in tumors <20 mm in diameter, and 5.3% (22 of 414) in tumors without lymphatic invasion. Among patients with a tumor <20 mm in diameter, the incidence of lymph node metastasis was significantly reduced in those with a differentiated tumor: 4.2% (4 of 95). These results were almost identical to those observed in the second population.Conclusions Lymph node status can be accurately predicted on the basis of pathologic tumor diameter <20 mm, lymphatic invasion (absence), and histological type (differentiated) in patients with submucosal gastric cancer. Less extensive surgery for these patients might be reconsidered after confirmation of the reproducibility of the results of this study by an appropriately designed prospective clinical trial.     

胃癌Krukenberg瘤与盆腔腹膜种植的临床病理特征及手术预后的比较

目的 比较胃癌Krukenberg瘤与盆腔腹膜种植的临床病理特征,分析手术对预后的影响.方法 1994年8月至2006年3月共收治女性胃癌伴盆腔转移患者39例,其中Krukenberg瘤18例,无Krukenberg瘤的盆腔腹膜种植21例,比较两组的临床病理特征,分析手术对总体病例预后的影响.结果 胃癌Krukenberg瘤和盆腔腹膜种植患者的年龄、肿瘤部位、大小、肝转移率、脏器侵犯率、浸润深度、阳性淋巴结数、组织类型、分化程度、Borrmann分型、癌胚抗原间等差异均无显著性意义(P>0.05).胃癌Krukenberg瘤的P3型腹膜种植率(44.4%)显著低于盆腔腹膜种植患者(85.7%)(P<0.05).胃癌Krukenberg瘤的病灶切除率(77.8%)、联合脏器切除率(55.6%)均显著高于盆腔腹膜种植者(38.0%、23.8%)(P<0.05).总体病例的平均生存期为12.6个月.胃癌Krukenberg瘤和盆腔腹膜种植病例的平均生存期分别为20.5、9.7个月(P<0.05).总体病例接受病灶全切除、病灶姑息切除和非病灶切除术的平均生存期分别为19.9、12.5、5.7个月,病灶切除能显著延长患者生存期(P<0.05).姑息手术、盆腔腹膜种植、P3型腹膜种植、肝转移、脏器侵犯、全胃癌、腹水为预后不良因素.结论 较无Krukenberg瘤的盆腔腹膜种植病例相比,胃癌Krukenberg瘤的腹膜扩散程度更为局限、手术切除率更高、预后更好,病灶切除对改善预后有益.     

Clinicopathological features and medical management of early gastric cancer

BACKGROUND: The detection of early gastric carcinoma (EGC) has increased worldwide due to advances in endoscopic techniques and equipment. The aim of the current study was to compare the clinicopathological findings of patients with and without lymph node metastasis. METHODS: A total of 440 cases of early gastric carcinoma in patients who underwent surgical procedures between 1981 and 2002 at Kochi Medical School were studied. RESULTS: Lymph node metastasis was observed in 38 patients (8.6%) with EGC. Multivariate analysis identified 4 independent risk factors of lymph node metastasis: (1) submucosal invasion; (2) tumor diameter greater than 3.5 cm; (3) the presence of vascular invasion; and (4) the presence of lymphatic permeation. CONCLUSION: For patients with tumor size between 1 cm and 3.5 cm we would recommend endoscopic resection initially, with a consideration for additional surgical resection if microscopic vascular invasion or lymphatic permeation is demonstrated.     

Kidney Metastasis of Resected Early Gastric Carcinoma: Report of a Case

We report a rare case of kidney metastasis of resected early gastric cancer in a 67-year-old man. We performed distal gastrectomy with D2 lymph node dissection for early gastric cancer, which was histologically diagnosed as moderately differentiated adenocarcinoma (T1N0M0, stage IA). Preoperatively, his serum carcinoembryonic antigen (CEA) level was 9.5 ng/ml, and this dropped to 7.0 ng/ml postoperatively. However, 1 year 10 months after the operation, we performed partial kidney resection and the lesion was confirmed to be a metastasis of the gastric cancer. Unfortunately, 5 months later, multiple liver metastasis was found, accompanied by a further increase in the serum CEA level to 2 650.8 ng/ml. This case illustrates the poor prognosis associated with a high preoperative serum CEA level, even if early gastric cancer is resected curatively.