Incidence of lymph node metastasis from early gastric cancer: estimation from 5,265 patients at two large centres
By analysing over 5,000 surgical cases, this study identified early gastric cancers with essentially zero risk of lymph node spread, defining the expanded criteria that allow endoscopic removal instead of gastrectomy.
Overview
Retrospective analysis of 5,265 patients who underwent gastrectomy with lymph node dissection for early gastric cancer at two Japanese centres, examining the incidence of nodal metastasis by depth, size, histology, ulceration and lymphovascular invasion.
No nodal metastases were found in differentiated intramucosal cancers without ulceration regardless of size, in ulcerated differentiated intramucosal cancers up to 3 cm, or in differentiated cancers with minute submucosal invasion up to 3 cm without lymphovascular invasion.
- Zero nodal metastasis in differentiated intramucosal cancers without ulceration of any size.
- Zero nodal metastasis in differentiated cancers with submucosal invasion under 500 micrometres up to 3 cm without lymphovascular invasion.
The expanded criteria for endoscopic submucosal dissection in Japanese and international guidelines derive from this analysis.
- Retrospective surgical series; undifferentiated-type criteria were validated later in JCOG1009/1010.