Clinicopathology of Early Gastric Cancer

Background and Purpose: The prognosis of early gastric cancer is considered to be satisfactory after a curative resection. The incidence of early gastric cancer is higher in Japan than that in the Western countries. Limited surgery is recommended now for early gastric cancer. Methods: 254 patients of early gastric cancer were retrospectively analyzed who were operated on in the period from 1974 to 2004. Lymph node dissection (D1 or D2) was performed in over 95% of all these patients. 242 patients (95.3%) underwent distal subtotal gastrectomy and 7 patients (2.8%) underwent proximal gastrectomy. 5 patients (2.0%) of larger tumor received total gastrectomy. Results: The most common symptom was abdominal pain (45.7%) followed by bleeding (18.1%) Over half (157 cases; 61.8 %) of the tumors were located in the lower third of the stomach. Macroscopically, most of the lesions were Ⅱc or Ⅱc+Ⅲ(113 lesions: Ⅱc; 86 lesions: Ⅱc+Ⅲ) 24 patients (9.5%) had level 1 lymph node metastasis and metastasis to the level 2 nodes was detected in 7 patients (2.8%). The 5-year survival rate for all the patients with early gastric cancer was 94.4%. The 5-year survival rates for patients of pN1 and pN2 were 85.7% and 80% respectively. Conclusion: There was no survival difference between mucosal and submucosal cancer. Lymph node involvement is the most important prognostic factor for early gastric cancer.