Advertisement

Annals of Surgical Oncology

, Volume 16, Issue 6, pp 1514–1519 | Cite as

Better Prognosis of T2 Gastric Cancer with Preoperative Diagnosis of Early Gastric Cancer

  • Masanori Tokunaga
  • Naoki Hiki
  • Tetsu Fukunaga
  • Shigekazu Ohyama
  • Kazuhiko Yamada
  • Toshiharu Yamaguchi
Gastrointestinal Oncology

Abstract

Background

Gastrectomy with D2 lymph node dissection is the standard treatment for locally advanced gastric cancer in Japan. However, in patients with a preoperative diagnosis of early gastric cancer, gastrectomy with limited lymph node dissection is generally selected as a treatment option, despite a pathological diagnosis of advanced gastric cancer. The aim of the present study was to clarify the clinicopathological characteristics and feasibility of limited lymph node dissection in patients with clinically early, but pathologically advanced, gastric cancer.

Materials and Methods

Clinicopathological characteristics, including the incidence and susceptible sites for lymph node metastasis, were investigated in 1528 patients with a final diagnosis of T2 gastric cancer treated at the Cancer Institute Hospital. For these patients, the results were compared between two groups including 266 patients preoperatively diagnosed as early T1 gastric cancer (EpT2) and 1262 patients preoperative diagnosed as locally advanced gastric cancer (ApT2).

Results

The pathological stage was lower (P < .001), and the 5-year survival rate was better (91.0% vs. 73.1%, P < .001) for the EpT2 group compared with the ApT2 group. Moreover, the N stage was smaller in the EpT2 group than in the ApT2 group, and the extension of lymph node metastasis was limited in 261 out of 266 patients (98%).

Conclusion

Patients with EpT2 gastric cancer had a better 5-year survival rate than the patients in the ApT2 group. Gastrectomy with limited lymph node dissection could be indicated for patients with EpT2 gastric cancer unless intraoperative finding indicated obvious lymph node metastasis.

Keywords

Gastric Cancer Advanced Gastric Cancer Tumor Depth Susceptible Site Japanese Gastric Cancer Treatment Guideline 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Kodera Y, Schwarz RE, Nakao A. Extended lymph node dissection in gastric carcinoma: where do we stand after the Dutch and British randomized trials? J Am Coll Surg. 2002;195:855–64.PubMedCrossRefGoogle Scholar
  2. 2.
    Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg. 1987;11:418–25.PubMedCrossRefGoogle Scholar
  3. 3.
    Lee SW, Shinohara H, Matsuki M, Okuda J, Nomura E, Mabuchi H, et al. Preoperative simulation of vascular anatomy by three-dimensional computed tomography imaging in laparoscopic gastric cancer surgery. J Am Coll Surg. 2003;197:927–36.PubMedCrossRefGoogle Scholar
  4. 4.
    Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.PubMedCrossRefGoogle Scholar
  5. 5.
    Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer. 2002;5:1–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Seto Y, Shimoyama S, Kitayama J, Mafune K, Kaminishi M, Aikou T, et al. Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer. Gastric Cancer. 2001;4:34–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Yamao T, Shirao K, Ono H, Kondo H, Saito D, Yamaguchi H, et al. Risk factors for lymph node metastasis from intramucosal gastric carcinoma. Cancer. 1996;77:602–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Sano T, Okuyama Y, Kobori O, Shimizu T, Morioka Y. Early gastric cancer. Endoscopic diagnosis of depth of invasion. Dig Dis Sci. 1990;35:1340–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Yanai H, Matsumoto Y, Harada T, Nishiaki M, Tokiyama H, Shigemitsu T, et al. Endoscopic ultrasonography and endoscopy for staging depth of invasion in early gastric cancer: a pilot study. Gastrointest Endos. 1997;46:212–6.CrossRefGoogle Scholar
  10. 10.
    Japanese Gastric Cancer A. Japanese Classification of Gastric Carcinoma, 2nd English ed. Gastric Cancer. 1998;1:10–24.Google Scholar
  11. 11.
    Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol. 2004;22:2069–77.PubMedCrossRefGoogle Scholar
  12. 12.
    Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;345:745–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996;347:995–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer. 1999;79:1522–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Shiraishi N, Yasuda K, Kitano S. Laparoscopic gastrectomy with lymph node dissection for gastric cancer. Gastric Cancer. 2006;9:167–76.PubMedCrossRefGoogle Scholar
  16. 16.
    Miura S, Kodera Y, Fujiwara M, Ito S, Mochizuki Y, Yamamura Y, et al. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a critical reappraisal from the viewpoint of lymph node retrieval. J Am Coll Surg. 2004;198:933–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Noshiro H, Nagai E, Shimizu S, Uchiyama A, Tanaka M. Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer. Surg Endosc. 2005;19:1592–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A. Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer. 1999;2:230–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Kim MC, Kim HH, Jung GJ. Surgical outcome of laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer. Eur J Surg Oncol. 2005;31:401–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Maruyama K, Kaminishi M, Hayashi K, Isobe Y, Honda I, Katai H, et al. Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry. Gastric Cancer. 2006;9:51–66.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Masanori Tokunaga
    • 1
  • Naoki Hiki
    • 1
  • Tetsu Fukunaga
    • 1
  • Shigekazu Ohyama
    • 1
  • Kazuhiko Yamada
    • 1
  • Toshiharu Yamaguchi
    • 1
  1. 1.Department of Gastroenterological SurgeryCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan

Personalised recommendations