CLINICAL STUDY OF EARLY GASTRIC CANCER WITH LYMPH NODE METASTASIS

Clinicopathological studies of 273 cases of early gastric cancer which had been operated on in an 18-year period from January 1973 to December 1990 were performed retrospectively, focusing on the lymph node metastasis and the possibility of reduction of surgical procedures. The incidences of lymph node metastasis were 2.0% in m cancers and 17.0% in sm cancers. Lymph node metastasis at No. 4, 5 and 6 were not observed in cancers of the region C, and those at No. 1, 2 and 3 were not observed in cancers of the region A. Gastric cancers of type IIb and IIa less than 2cm in diameter did not show any lymph node metastasis. There was no relationship between histologic type and lymph node metastasis. All six patients, died of the original gastric cancer, had sm cancer with lymph node metastasis. Preoperative diagnosis of the deapth of invasion turned out underestimation compared to actual deapth confirmed by resected specimen in a rate of 6.7%, and hence, sm cancers might not to be candidates for reduction surgery. From these results, it is indicated that proximal gastrectomy with No. 7, 8 lymph node dissection form cancer in region C and, distal gastrectomy with No. 7, 8 lymph node dissection with hepatic branch of the vagal nerve preserved for m cancer in region A are surgical procedures of choice, and that for IIb and IIa cancers less than 2cm in diameter, gastrectomy with R1 lymph node dissection is enough.