Predicting the absence of lymph node metastasis of submucosal invasive gastric cancer: Expansion of the criteria for curative endoscopic resection

Scandinavian Journal of Gastroenterology Volume 45 Issue 12 Page 1480-1487 published_at 2010-12
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Title ( eng )
Predicting the absence of lymph node metastasis of submucosal invasive gastric cancer: Expansion of the criteria for curative endoscopic resection
Creator
Oka Shiro
Higashiyama Makoto
Shimamoto Fumio
Source Title
Scandinavian Journal of Gastroenterology
Volume 45
Issue 12
Start Page 1480
End Page 1487
Abstract
Objective. The conditions upon which endoscopic resection (ER) can be considered curative for submucosal invasive gastric cancer remain controversial; thus, unnecessary surgery is sometimes performed after ER. Our purpose is to evaluate the significance of several clinicopathological factors for predicting the absence of lymph node (LN) metastasis of submucosal invasive gastric cancer and thus determining cases in which ER can be considered curative.

Patients and methods. The study group comprised 220 patients with submucosal invasive gastric cancer that was resected surgically or endoscopically. Patients treated by ER underwent additional surgical resection. The presence of LN metastasis was evaluated in all patients, retrospectively.

Results. LN metastasis was detected in 37 (16.8%) of the 220 patients. Independent risk factors for LN metastasis were width of submucosal invasion >6000 mu m, lymphatic involvement, undifferentiated type at the deepest invasive portion, depth of submucosal invasion >1000 mu m, and tumor diameter >30 mm. The group of 36 patients with submucosal invasion to a depth of <= 1000 mu m, tumor diameter <= 30 mm, differentiated type as the dominant histologic type, and absence of vessel involvement was entirely free of LN metastasis (95% confidence interval, 0-8.0%).

Conclusions. Taken together, the five independent risk factors may allow expansion of the criteria for determining whether ER for submucosal invasive gastric cancer has been curative.
Keywords
Endoscopic resection
ESD
lymph node metastasis
submucosal invasive gastric cancer
NDC
Medical sciences [ 490 ]
Language
eng
Resource Type journal article
Publisher
Taylor & Francis AS
Date of Issued 2010-12
Rights
Copyright (c) 2010 Informa Plc.
Publish Type Author’s Original
Access Rights open access
Source Identifier
[ISSN] 0036-5521
[DOI] 10.3109/00365521.2010.505659
[NCID] AA00833522
[DOI] http://dx.doi.org/10.3109/00365521.2010.505659