Pathological Predictors of Lymph Node Involvement in Submucosal Gastric Carcinoma: A Retrospective Analysis of Long-Term Outcome

BACKGROUND: The incidence of nodal metastasis in early gastric cancer (EGC) ranges from 5.7 to 13% . Since most patients with EGC do not have lymph node metastasis, the validity of extended nodal dissection has been questioned. PATIENTS AND METHODS: Clinicopathological data of 116 patients with EGC, all undergoing D2 lymphadenectomy, were analysed. Patients with or without lymph node metastases were compared in relation to age and gender distribution, tumour histopathology and 10-year prognosis. RESULTS: The overall rate of nodal metastasis was 9.5%. The invasion of submucosa, Lauren's diffuse type, a diameter greater than 3 cm, and Pen-A and Pen-B growth patterns were significantly associated with an increased incidence of lymph node metastasis. On multivariate analysis, the diffuse type was an independent risk factor for lymph node involvement, regardless of tumour size and growth pattern (p=0.007). Ten-year survival analysis showed no significant correlation with lymph node metastasis (86.5% vs. 71.6%). CONCLUSION: Submucosal carcinomas of intestinal type, under 2 cm in size, are eligible for minimally invasive surgery while, in diffuse-type carcinomas over 2 cm, standard surgery with D2 lymphadenectomy is recommended.