Evaluation of limited operation for early gastric cancer - follow-up study

We investigated the standards for determining the limited operation (D1 + No. 7 lymph node dissection) for early gastric cancer according to the clinicopathological features, and the relationship between the degree of lymph node dissection and prognosis of the disease. The subjects were 320 patients suffering from early gastric cancer. The rates of lymph node metastasis of mucosal and submucosal cancer were 2.7% and 30.9%, respectively. The lymph node metastatic rate of submucosal gastric cancer was significantly higher than that of mucosal gastric cancer. However, for tumors less than 4.0 cm in diameter, distribution of lymph node metastasis was confined to the area adjacent to that in which the tumor existed. Metastasis to the lymph node in the second group could be seen only in lymph node No. 7. As for the relationship between the degree of lymph node dissection and outcome of the disease, there was no difference between lymph node dissection in the first group (Dl) with lymph node No. 7 and in the second group (D2). Consequently, we assumed that the limited operation could be indicated in most cases of early gastric cancer. But the incidende of recurrence in the advanced type was significantly higher (37.5%) than in other types. Furthermore, in patients with the elevated, depressed, flat and mixed types of tumor, which were 4.0 cm or more in size, there was a high incidence of lymph node metastasis in the second or beyond group. We concluded that we should select these patients for extended dissection of Ivmoh nodes.