1993 Volume 39 Issue 2 Pages 200-208
Lymph node metastasis is a serious problem in performing reduction surgery for early gastric cancer. To determine the influence of accompanying ulcers on lymph node metastasis in depressed type early gastric cancer, a clinicopathological study was conducted by dividing the ulcers in cancer lesions into four types : UI (-), UI-II, UI-III, and UI-IV, in accordance with Murakami's classification. The invasive patterns of these cancers in the submucosal layer were assessed in four categories : minute, scattered, diffuse, and massive. Cancers which did not invade beyond the mucosa had no lymph node metastasis. Tiny cancers with a diameter of less than 1.0cm also had no lymph node metastasis. Small cancers (from 1.0cm to 2.0cm in diameter) had lymph node metastasis only when ulcers were present within the cancer lesions. Large cancers with a diameter of 5.0cm or more had a high incidence of lymph node metastasis (45.5% for UI-III and 50.0% for UI-IV). Even when lymphatic invasion was negatiave, lymph node metastasis was positive when ulcers were present within the cancers. In cancers showing a minute or scattered invasion pattern, lymph node metastasis was sometimes positive if ulcers were present within the cancer lesions, particularly for those in groups UI-III or UI-IV. Lymph node metastasis was always positive in cancers showing diffuse invasion of the submucosal layer in group UI-III, and those showing scattered or diffuse invasion in group UI-IV.
