Lymph node metastasis from intestinal-type early gastric cancer: experience in a single institution and reassessment of the extended criteria for endoscopic submucosal dissection - 24/08/11
Reprint requests: Do Youn Park, MD, PhD, Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, 1-10 Ami-Dong, Seo-Gu, Busan 602-739 KoreaRésumé |
Background |
Given the increasing use of endoscopic resection as a therapeutic modality for cases of early gastric cancer (EGC), it is very important to define strict criteria for the use of endoscopic mucosal resection and endoscopic submucosal dissection. To date, the criteria are almost entirely based on Japanese literature evaluating the risk of lymph node (LN) metastasis in patients with EGC.
Objective |
To analyze our own experience with the factors affecting LN metastasis and to reappraise the extended criteria for endoscopic submucosal dissection.
Design |
Retrospective, single-center study.
Setting |
University teaching hospital.
Patients |
This study involved 478 patients who underwent gastrectomy with LN dissection (n = 270, mucosal [m] EGC; n = 208, submucosal [sm] EGC).
Intervention |
Gastrectomy with LN dissection.
Main Outcome Measurements |
LN metastasis.
Results |
Overall, 12.6% (60/478) of patients with EGCs presented with LN metastasis (mEGC, 3.0% [8/270], smEGC, 25.0% [52/208]). Increased size, macroscopic type (elevated), depth of invasion, and lymphovascular invasion were associated with LN metastasis. In 270 cases of mEGC, there was no relationship between clinicopathologic features and LN metastasis. In the smEGC group, size, depth of invasion, and lymphovascular emboli were associated with an increased risk of LN metastasis. Significantly, LN metastasis was noted in EGCs falling within established extended endoscopic submucosal dissection criteria, that is, intestinal-type mucosal cancer of any size without ulcer and no lymphovascular emboli (2/146 [1.4%]) or ≤3 cm with no lymphovascular emboli and irrespective of the presence of ulceration (2/126 [1.6%]) or intestinal-type submucosal cancer (sm1, <500 μm) without lymphovascular invasion and measuring ≤3 cm in size (3/20 [15.0%]).
Limitations |
Retrospective review of a single-center study.
Conclusion |
We recommend that more centers survey their experiences of LN metastasis in cases of EGC to refine the criteria for endoscopic submucosal dissection as a therapeutic modality of intestinal-type EGC.
Le texte complet de cet article est disponible en PDF.Abbreviations : EGC, ESD, LN, mEGC, sm1, smEGC, sm1, sm2
Plan
| DISCLOSURE: This study was supported by grant 0920050 from the National R&D Program for Cancer Control, Ministry for Health, Welfare and Family Affairs, Republic of Korea. All other authors disclosed no financial relationships relevant to this publication. H.J. Kang and D.H. Kim equally contributed in this work. D.Y. Park and G.Y. Lauwers share senior authorship. |
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| If you would like to chat with an author of this article, you may contact Dr Park at pdy220@pusan.ac.kr. |
Vol 72 - N° 3
P. 508-515 - septembre 2010 Retour au numéro
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