SURGICAL MANAGEMENT FOR EARLY GASTRIC CANCER AS CONSIDERED FROM THE VIEWPOINT OF LYMPH NODE METASTASIS

Lymph node metastasis was studied in 263 patients with early gastric cancer, and the possibility of limited surgery for carcinoma confined to the mucosa (m-carcinoma) was discussed. Among these patients, 21 (8.0%) were lymph node metastasis-positive. Lymph node metastasis was noted in 5 (3.3%) of 153 patients with m-carcinoma and 16 (14.5%) of 110 patients with carcinoma limited to the submucosa (sm-carcinoma). Lymph node metastasis-positive cases of depressed-type mcarcinoma were characterized by ulcer of ul-III or IV type in relatively wide spread cancerous lesion. The lymph node metastasis-positive cases of protruded-type m-carcinoma consisted of one case of type I composed of poorly differentiated adenocarcinoma and one case with lymph vessel invasion of type IIa+IIc (multiple gastric cancer). Lymph node metastasis-negative cases of m-carcinoma were characterized by small lesions of type IIa, IIb and IIc associated with no ulcer in the cancerous lesion. In surgical management for these cases, it may thus be possible to reduce the extent of lymph node dissection.