Original CommunicationsLess invasive surgery for early gastric cancer based on the low probability of lymph node metastasis☆
Section snippets
Material and methods
Of 890 consecutive patients who underwent standard resection for early gastric cancer at the Department of Surgery I, Tottori University Hospital, during the 25-year period from 1968 to 1992, 441 had mucosal cancer and 449 had submucosal cancer. These patients were treated by means of distal or proximal resection of more than two thirds of the stomach or by means of total gastrectomy. All underwent dissection of at least group 1 lymph nodes. Group 1 and group 2 lymph nodes were dissected in
Survival of patients
The cumulative survival rate was calculated by an actuarial method. Ten-year survival rates were 79.2% in cases with muco-sal cancer and 74.0% in cases with submucosal cancer. There was no significant difference in prognosis between patients with mucosal and submucosal cancers. The mean follow-up period for those who underwent operation for early gastric cancer was 10 years, and 24 cases (2.7%) recurred. Nine of these 24 patients had lymph node involvement at the time of the first operation.
Discussion
Lymph node metastasis is a critical factor that influences the recurrence of early gastric cancer.12, 13 However, lymph node metastases are pres-ent in only a small fraction of patients with early gastric cancer. The need for extensive lymph node dissection has been questioned in patients with small mucosal cancers.14, 15 Most metastatic lymph nodes in early gastric cancer are confined to the perigastric region, and limited lymphadenectomy is usually satisfactory in these cases.16 However,
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Reprint requests: Shunichi Tsujitani, MD, PhD, Tottori University, Faculty of Medicine, Department of Surgery I, 36-1 Nishi-cho, Yonago 683, Japan.