1999 Volume 54 Pages 52-56
In selecting the therapeutic procedure of gastric cancer, surgical treatment with wide lymph node dissection has been mostly applied for radical resection. In recent years, early gastric cancer not requiring lymph node dissection is increasingly treated by endoscopic membrane resection or laparoscopic local resection. However, there is a risk of lymph node metastasis and the regional lymph node dissection is required in early gastric cancer with submucosal infiltration. The cases of early gastric cancer are largely divided into the following three : (1) those which dose not require lymph node dissection, (2) those which can be well treated by D1 or D1＋＃7 lymph node dissection and (3) those which dose not require D2 lymph node dissection. We should be very careful in selecting the therapy.
The authors histopathologically investigated the specimens taken from early gastric cancer cases operated at our institution from 1987 to 1997 and investigated the therapeutic option for early gastric cancer requiring lymph node dissection. The size, histological type, depth, and presence or absence of ulcer and lymph node metastasis were investigated for the lesions from 200 early gastric cancer cases (100 mucosal gastric cancer cases and 100 submucosal invasive gastric cancer cases) . The investigation indicated that minute invasion (sm1) has no lymph node metastasis regardless of presence or absence of ulcer and is an indication of LADG (no more than D1 dissection) . And that moderately invasion (sm2) cancer lesions of less than 4cm for differentiated type and less than 1.5cm for undifferentiated type with absence of ulcer can be an indication of the same operation. And other sm2 cancer cases can be the extended indication of LADG (D1＋＃7 dissection) . The submucosal invasive cancer cases severer than these will be an indication of conventional distal gastrectomy (D2 dissection) .
