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Early gastric cancer (EGC) defined as gastric cancer involving up to submucosal layer, regardless of lymph node metastasis, is increasingly found at Siriraj Hospital. Understanding the characteristic of EGC and result of surgical management for EGC can help to choose the optimal treatment. In the present study, the authors reported the first case series in Thailand.The authors analyzed 21 consecutive EGC patients treated with gastrectomy with lymph node dissection between September 2001 and December 2009 at Minimally Invasive Surgery Center, Division of General Surgery, Department of Surgery, Siriraj Hospital, Mahidol University, Thailand.Ratio of EGC to total cases of gastric cancer was increasing yearly, from 1.8% in 2006 to 8.1% in 2009 at Siriraj Hospital. The most common type of EGC was type IIc (66.7%) while type III was found in 19%, and type I in 14.3%. The tumor invaded mucosal layer in 42.9% and submucosal layer in 57.1% of the patients. For N staging, 76.2% of the patients were N0 while N1 was 19% and N2 was 4.8%. Overall, lymph node metastasis was found in 23.8%. For mucosal cancer (m), no lymph node metastasis was seen while for submucosal cancer (sm) five cases (41.7%) had lymph node metastasis, especially in one patient that the metastasis was in N2 group. Lymphatic invasion was seen in 14.3% of cases. All cases with lymphatic invasion were all submucosal cancer. Overall staging was stage 1a in 76.2%, stage 1b in 19%, and stage 2 in 4.8%. Morbidity was seen in 14.3% of the cases. No mortality was seen. The survival was excellent with no recurrence found during the follow-up period of the present study (mean 30.53 months).Surgery for EGC has good results with minimal complications and excellent 5-year survival. Less invasive treatment has become the option for EGC. Understanding the characteristic of EGC and careful selection to assign appropriate treatment is important to improve the result in the treatment of EGC.

Radical esophagectomy was reported to have prolonged survival in patients with esophageal cancer However, it is associated with high morbidity and mortality. Controversy still exists regarding value of radical esophagectomyThe authors analyzed the results, including complications and survival in 68 consecutive patients with esophageal cancer who were treated with transthoracic radical esophagectomy at the Department of Surgery, Siriraj hospital, Mahidol University between June 2002 and June 2008.There were 57 males and eight females with a mean age of 59.28 +/- 11.25 years. Regarding T staging, 81.5% of the patients were in T3 stage while 1.5% of the patients had Ti stage, 15.4% had T2 stage, and 1.5% had T4 stage. Lymph node metastasis (NI) was found in 63.1% of the patients and NO was in 36.9%. Most of the patients were in advanced stages with 53.8% in stage III, 44.6% in stage II, and 1.5% in stage I. The 5-year survival rate of the patients with node positive was significantly lower than the patients with node negative (p = 0.018). The survival was significantly better in stage Ilcompared to stage III (p = 0.012). Overall 5-year survival rate was 28. 5%. Most common complications were from pulmonary causes (22.1%), anastomotic leakage (8.8%), and wound infection (8.8%). Mortality rate was 4.41%.Radical esophagectomy was associated with relatively low mortality and acceptable survival. It should be considered in surgical treatment of patients with esophageal cancer

Extent of lymph node dissection still remains one of the most controversial issues regarding radical gastrectomy. Knowledge of the pattern and incidence of lymph node metastasis may help to define the optimal extent of lymph node dissection.The authors analyzed lymph node metastasis and survival rate in 130 consecutive gastric cancer patients who underwent radical gastrectomy with D2 dissection between June 2001 and October 2008 at the Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand.For N staging, 28.5% of the patients were N0 while N1 was 40% and N2 was 31.5%. 44% of the patients with lymph node positive had metastasis up to group 2 lymph nodes. The patients with node positive had 5 year survival of 39% while the patients with node negative had survival of 73% (p = 0.003). Tumor at the middle part of the stomach had the most widespread lymph node metastasis compared to other regions. Lymph node group 7, 8 and 9 had a high incidence of lymph node metastasis especially for distal cancer while lymph node group 10, 11, 12 had lower incidence of metastasis. No mortality was seen in the present study.N staging, number of metastatic node5 and angiolymphatic invasion were the lymph node related factors contributing to survival. For radical gastrectomy, D2 dissection is required for adequate clearance of metastatic lymph nodes, which can be done without mortality.