[Clinicopathological features and long-term results of surgical therapy of early gastric cancer]

Abstract

Objective: To investigate factors implicated in the relapse of early gastric cancer (EGC), and to explore the mode of lymphadenectomy (over-D(1) vs D(2)) for EGC patients.

Methods: The data of 161 EGC patients, diagnosed from Jul. 1979 to Aug. 2004, were investigated in the study retrospectively.

Results: One hundred and sixty-one EGC cases accounted for 6.0% of the total gastric cancer cases during the same period (161/2694). D(2) lymphadenectomy were performed in 112/161 cases, and over-D(1) in 49/161. Among these cases, 9 developed distant metastases (7 in liver and 2 in bone), 3 local recurrences in remaining gastric, and 3 lymph node metastases. The 5 and 10-year survival rates were 90.7% and 89.8% respectively. The risk factors associated with recurrence included lymph node metastases, depth of invasion, lymphatic involvement, number of tumors, vessel involvement, tumor size, age and lymphadenectomy (P<0.05) through univariate analysis. Further multivariate analysis showed that lymph node metastases, vessel involvement, gross type and extent of lymphadenectomy as independent effective factors for recurrence. Compared with over-D(1) mode, D(2) mode conferred a significantly increased cumulative survival for cancer invaded the submucosa. No significant difference in cumulative survival for mucosa invasive EGC was found between over-D(1) and D(2) modes.

Conclusions: Lymph node metastases and vessel involvement act as independent risk factors for recurrence of EGC. Adversely, protrusion lesion and D(2) lymphadenectomy are shown as protection factors for recurrence of EGC. Standard D(2) lymphadenectomy should be carried out in EGC with submucosal invasion or positive sentinel nodes or depressed lesions (IIc + III).