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Published in: Annals of Surgical Oncology 2/2007

01-02-2007

Surgical Results of Early Gastric Cancer and Proposing a Treatment Strategy

Authors: Su-Shun Lo, MD, Chew-Wun Wu, MD, Jen-Hao Chen, MD, Anna Fen-Yau Li, MD, Mao-Chie Hsieh, MD, King-Han Shen, MD, Hwai-Jeng Lin, MD, Win-Yiu Lui, MD

Published in: Annals of Surgical Oncology | Issue 2/2007

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Abstract

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.
Literature
1.
go back to reference Maehara Y, Orita H, Okuyama T, Moriguchi S, Tsujitani S, Korenaga D, et al. Predictors of lymph-node metastasis in early gastric cancer. Br J Surg 1992; 79:245–247PubMedCrossRef Maehara Y, Orita H, Okuyama T, Moriguchi S, Tsujitani S, Korenaga D, et al. Predictors of lymph-node metastasis in early gastric cancer. Br J Surg 1992; 79:245–247PubMedCrossRef
2.
go back to reference Habu H, Takeshita K, Sunawaga M, Endo M. Lymph node metastases in early gastric cancer. Int Surg 1986; 71:244–247PubMed Habu H, Takeshita K, Sunawaga M, Endo M. Lymph node metastases in early gastric cancer. Int Surg 1986; 71:244–247PubMed
3.
go back to reference Guadagni S, Reed PI, Johnston BJ, De Bernardinis G, Catarci M, Valenti M, et al. Early gastric cancer: follow up after gastrectomy in 159 patients. Br J Surg 1993; 80:325–328PubMedCrossRef Guadagni S, Reed PI, Johnston BJ, De Bernardinis G, Catarci M, Valenti M, et al. Early gastric cancer: follow up after gastrectomy in 159 patients. Br J Surg 1993; 80:325–328PubMedCrossRef
4.
go back to reference Folli S, Dente M, Dell’ Amore D, Gaudio M, Nanni O, Saragoni L, et al. Early gastric cancer: prognostic factor in 223 patients. Br J Surg 1995; 82:952–956PubMedCrossRef Folli S, Dente M, Dell’ Amore D, Gaudio M, Nanni O, Saragoni L, et al. Early gastric cancer: prognostic factor in 223 patients. Br J Surg 1995; 82:952–956PubMedCrossRef
5.
go back to reference Kitamura K, Yamaguchi T, Taniguchi M, Hagowara A, Sawai K, Takahashi T. Analysis of lymph node metastasis in early gastric cancer: rationale of limited surgery. J Surg Oncol 1997; 64:42–47PubMedCrossRef Kitamura K, Yamaguchi T, Taniguchi M, Hagowara A, Sawai K, Takahashi T. Analysis of lymph node metastasis in early gastric cancer: rationale of limited surgery. J Surg Oncol 1997; 64:42–47PubMedCrossRef
6.
go back to reference Sano T, Sasako M, Kinoshita T, Maruyama K. Recurrence of early gastric cancer: follow-up of 1475 patients and review of Japanese literature. Cancer 1993; 72:3174–3178PubMedCrossRef Sano T, Sasako M, Kinoshita T, Maruyama K. Recurrence of early gastric cancer: follow-up of 1475 patients and review of Japanese literature. Cancer 1993; 72:3174–3178PubMedCrossRef
7.
go back to reference Basili G, Nesi G, Barchielli A, Manetti A, Biliotti G. Pathologic features and long-term results in early gastric cancer; report of 116 cases 8–13 years after surgery. World J Surg 2003; 27:149–152PubMed Basili G, Nesi G, Barchielli A, Manetti A, Biliotti G. Pathologic features and long-term results in early gastric cancer; report of 116 cases 8–13 years after surgery. World J Surg 2003; 27:149–152PubMed
8.
go back to reference Borie F, Millat B, Fingerhut A, Hay JM, Fagniez PL, De Saxce B. Lymphatic involvement in early gastric cacner: prevalence and prognosis in France. Arch Surg 2000; 135:1218–1223PubMedCrossRef Borie F, Millat B, Fingerhut A, Hay JM, Fagniez PL, De Saxce B. Lymphatic involvement in early gastric cacner: prevalence and prognosis in France. Arch Surg 2000; 135:1218–1223PubMedCrossRef
9.
go back to reference Schlemper RJ, Itabashi M, Kato Y. Differences in diagnostic criteria for gastric carcinoma between Japanese and Western pathologists. Lancet 1997; 349:1725–1729PubMedCrossRef Schlemper RJ, Itabashi M, Kato Y. Differences in diagnostic criteria for gastric carcinoma between Japanese and Western pathologists. Lancet 1997; 349:1725–1729PubMedCrossRef
10.
go back to reference Lauren P. The two histological main types of gastric carcinoma. Diffuse and so-called intestinal type of carcinoma: an attempt at a histoclinical classification. Acta Pathol Microbio Scand 1965; 64:31–49 Lauren P. The two histological main types of gastric carcinoma. Diffuse and so-called intestinal type of carcinoma: an attempt at a histoclinical classification. Acta Pathol Microbio Scand 1965; 64:31–49
11.
go back to reference Japanese Research Society for Gastric Cancer. Japanese classification of gastric carcinoma, 1st Engl edn. Tokyo: Kanehara Shuppan 1995 Japanese Research Society for Gastric Cancer. Japanese classification of gastric carcinoma, 1st Engl edn. Tokyo: Kanehara Shuppan 1995
12.
go back to reference Sano T, Kobori O, Muto T. Lymph node metastasis from early gastric cancer; endoscopic resection of tumor. Br J Surg 1992; 79:241–244PubMedCrossRef Sano T, Kobori O, Muto T. Lymph node metastasis from early gastric cancer; endoscopic resection of tumor. Br J Surg 1992; 79:241–244PubMedCrossRef
13.
go back to reference Lee HJ, Kim YH, Kim WH, Lee KU, Choe KJ, Kim JP, Yang HK. Clinicopathological analysis of recurrence of early gastric cancer. Jpn J Clin Oncol 2003; 33:209–214PubMedCrossRef Lee HJ, Kim YH, Kim WH, Lee KU, Choe KJ, Kim JP, Yang HK. Clinicopathological analysis of recurrence of early gastric cancer. Jpn J Clin Oncol 2003; 33:209–214PubMedCrossRef
14.
go back to reference Maehara Y, Okuyama T, Oshiro T, Baba H, Anai H, Akazawa K, Sugimachi K. Early cancer of the stomach. Surg Gyneco Obstet 1993; 177:593–597 Maehara Y, Okuyama T, Oshiro T, Baba H, Anai H, Akazawa K, Sugimachi K. Early cancer of the stomach. Surg Gyneco Obstet 1993; 177:593–597
15.
go back to reference Lawerence M, Shiu MH. Early gastric cancer. Twenty-eight-year experience. Ann Surg 1991; 213:327–334CrossRef Lawerence M, Shiu MH. Early gastric cancer. Twenty-eight-year experience. Ann Surg 1991; 213:327–334CrossRef
16.
go back to reference Folli S, Morgagni P, Roviello F, De Manzoni G, Marrelli D, Saragoni L, et al. Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC). Jpn J Clin Oncol 2001; 31:495–499PubMedCrossRef Folli S, Morgagni P, Roviello F, De Manzoni G, Marrelli D, Saragoni L, et al. Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC). Jpn J Clin Oncol 2001; 31:495–499PubMedCrossRef
17.
go back to reference Ichiyoshi U, Toda T, Minamisono Y, Nagasaki S, Yakeishi Y, Sugimachi K. Recurrence in early gastric cancer. Surgery 1990; 107:489–495PubMed Ichiyoshi U, Toda T, Minamisono Y, Nagasaki S, Yakeishi Y, Sugimachi K. Recurrence in early gastric cancer. Surgery 1990; 107:489–495PubMed
18.
go back to reference Siewert JR, Kestlmeier R, Bush R, et al. Benefits of D2 lymph node dissection for patients with gastric cancer and pN0 and pN1 lymph node metastases. Br J Surg 1996; 83:1144–1147PubMedCrossRef Siewert JR, Kestlmeier R, Bush R, et al. Benefits of D2 lymph node dissection for patients with gastric cancer and pN0 and pN1 lymph node metastases. Br J Surg 1996; 83:1144–1147PubMedCrossRef
19.
go back to reference Baba H, Maehara Y, Takeuchi H, et al. Effect of lymph node dissection on the prognosis in patients with node-negative early gastric cancer. Surgery 1995; 117:165–169PubMedCrossRef Baba H, Maehara Y, Takeuchi H, et al. Effect of lymph node dissection on the prognosis in patients with node-negative early gastric cancer. Surgery 1995; 117:165–169PubMedCrossRef
20.
go back to reference Maehara Y, Oshiro T, Endo K, et al. Clinical significance of occult micromertastasis in lymph nodes from patients with early gastric cancer who died of recurrence. Surgery 1996; 119:397–402PubMedCrossRef Maehara Y, Oshiro T, Endo K, et al. Clinical significance of occult micromertastasis in lymph nodes from patients with early gastric cancer who died of recurrence. Surgery 1996; 119:397–402PubMedCrossRef
21.
go back to reference Cai J, Ikewguchi M, Maeta M, et al. Micrometastasis in lymph nodes of microinvasion of the muscularis propria in primary lesions of submucosal gastric cancer. Surgery 2000; 127:32–39PubMedCrossRef Cai J, Ikewguchi M, Maeta M, et al. Micrometastasis in lymph nodes of microinvasion of the muscularis propria in primary lesions of submucosal gastric cancer. Surgery 2000; 127:32–39PubMedCrossRef
22.
go back to reference Stachura J, Zembala M, Heitzman J, et al. Lymph node micrometastases in early gastric carcinoma alone inadequately reflect the new model of metastatic development. Pol J Pathol 1998; 49:155–157PubMed Stachura J, Zembala M, Heitzman J, et al. Lymph node micrometastases in early gastric carcinoma alone inadequately reflect the new model of metastatic development. Pol J Pathol 1998; 49:155–157PubMed
23.
go back to reference Morgagni P, Saragoni L, Scarpi E, Zattini PS, Zaccaroni A, Morgagni D, Bazzocchi F. Lymph node micrometastases in early gastric cacner and their impact on prognosis. World J Surg 2003; 27:558–561PubMedCrossRef Morgagni P, Saragoni L, Scarpi E, Zattini PS, Zaccaroni A, Morgagni D, Bazzocchi F. Lymph node micrometastases in early gastric cacner and their impact on prognosis. World J Surg 2003; 27:558–561PubMedCrossRef
25.
go back to reference Kojima T, Parra-Blanco A, Takahashi H, Rikiya F. Outcome of endoscopic mucosal resectionfor early gastric cancer: review of the Japanese literature. Gastrointest Endosc 1998; 48:550–555PubMed Kojima T, Parra-Blanco A, Takahashi H, Rikiya F. Outcome of endoscopic mucosal resectionfor early gastric cancer: review of the Japanese literature. Gastrointest Endosc 1998; 48:550–555PubMed
26.
go back to reference Ono H, Kondo H, Gotoda T, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48:225–229PubMedCrossRef Ono H, Kondo H, Gotoda T, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48:225–229PubMedCrossRef
27.
go back to reference Takekoshi T, Baba Y, Ota H, et al. Endoscopic resection of early gastric carcinoma; results of restrospective analysis of 308 cases. Endoscopy 1994; 26:352–358PubMedCrossRef Takekoshi T, Baba Y, Ota H, et al. Endoscopic resection of early gastric carcinoma; results of restrospective analysis of 308 cases. Endoscopy 1994; 26:352–358PubMedCrossRef
28.
go back to reference Arima N, Adachi K, Katsube T, et al. Predictive factors for metachronous recurrence of early gastric cancer after endoscopic treatment. J Clin Gastroenterol 1999; 29:44–47PubMedCrossRef Arima N, Adachi K, Katsube T, et al. Predictive factors for metachronous recurrence of early gastric cancer after endoscopic treatment. J Clin Gastroenterol 1999; 29:44–47PubMedCrossRef
29.
go back to reference Kawamura A, Adachi K, Ishihara S, et al. Correlation between microsatellite instability and metachronous disease recurrence after endoscopic mucosal resection in patients with early stage gastric carcinoma. Cancer 2001; 91:339–345PubMedCrossRef Kawamura A, Adachi K, Ishihara S, et al. Correlation between microsatellite instability and metachronous disease recurrence after endoscopic mucosal resection in patients with early stage gastric carcinoma. Cancer 2001; 91:339–345PubMedCrossRef
30.
go back to reference Fukutomi H, Sakita T. Analysis of early gastric cancer cases collected from major hospitals and institutes in Japan. Jpn J Clin Oncol 1984; 14:169–179PubMed Fukutomi H, Sakita T. Analysis of early gastric cancer cases collected from major hospitals and institutes in Japan. Jpn J Clin Oncol 1984; 14:169–179PubMed
31.
go back to reference Akahoshi K, Chijiiwa Y, Hamada S, Sasaki I, Maruoka A, Kabemura T, et al. Endoscopic ultrasonography: a promising method for assessing the prospects of endoscopic mucosal resection in early gastric cancer. Endoscopy 1997; 29:614–619PubMed Akahoshi K, Chijiiwa Y, Hamada S, Sasaki I, Maruoka A, Kabemura T, et al. Endoscopic ultrasonography: a promising method for assessing the prospects of endoscopic mucosal resection in early gastric cancer. Endoscopy 1997; 29:614–619PubMed
32.
go back to reference Nakamura K, Morisaki T, Sigitani A, Ogawa T, Uchiyama A, Kinukawa N, Tanaka M. An early gastric carcinoma treatment strategy based on analysis of lymph node metastasis. Cancer 1999; 85:1500–1505PubMedCrossRef Nakamura K, Morisaki T, Sigitani A, Ogawa T, Uchiyama A, Kinukawa N, Tanaka M. An early gastric carcinoma treatment strategy based on analysis of lymph node metastasis. Cancer 1999; 85:1500–1505PubMedCrossRef
33.
go back to reference Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48:22–229CrossRef Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48:22–229CrossRef
34.
go back to reference Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S. Laparoscopy-assisted Billroth I gastrectomy compared with conventional openb gastrectomy. Arch Surg 2000; 135:806–810PubMedCrossRef Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S. Laparoscopy-assisted Billroth I gastrectomy compared with conventional openb gastrectomy. Arch Surg 2000; 135:806–810PubMedCrossRef
35.
go back to reference Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open versus laparoscopic-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 2002; 131(suppl):S306–311PubMedCrossRef Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open versus laparoscopic-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 2002; 131(suppl):S306–311PubMedCrossRef
Metadata
Title
Surgical Results of Early Gastric Cancer and Proposing a Treatment Strategy
Authors
Su-Shun Lo, MD
Chew-Wun Wu, MD
Jen-Hao Chen, MD
Anna Fen-Yau Li, MD
Mao-Chie Hsieh, MD
King-Han Shen, MD
Hwai-Jeng Lin, MD
Win-Yiu Lui, MD
Publication date
01-02-2007
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 2/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-006-9077-x

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