Problems in the definition and treatment of early gastric cancer

Kazutom O Inoue, T Tobe, N Kan, Y Nio, M Sakai, E Takeuchi, T Sugiyama

doi:10.1002/bjs.1800780717

Problems in the definition and treatment of early gastric cancer

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Kazutom O Inoue

First Department of Surgery, Faculty of Medicine, Kyoto University, Kyoto, Japan
T Tobe

First Department of Surgery, Faculty of Medicine, Kyoto University, Kyoto, Japan
N Kan

First Department of Surgery, Faculty of Medicine, Kyoto University, Kyoto, Japan
Y Nio

First Department of Surgery, Faculty of Medicine, Kyoto University, Kyoto, Japan
M Sakai

Department of Endoscopy, Faculty of Medicine, Kyoto University, Kyoto, Japan
E Takeuchi

Department of Pathology, Faculty of Medicine, Kyoto University, Kyoto, Japan
T Sugiyama

Department of Pathology, Faculty of Medicine, Kyoto University, Kyoto, Japan

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<jats:title>Abstract</jats:title> <jats:p>Radical operation with extensive dissection of lymph nodes (R1 48 patients; R2, 196 patients; R3, one patient) was performed in 245 out of 247 patients with early gastric cancer. The 5-year survival rate was only 73.2 per cent in the 34 patients with lymph node metastases (31·8 per cent). Analysis of factors influencing recurrence revealed that not only lymph node metastases but also the depth of cancer invasion could affect prognosis in early gastric cancer. This study suggests that radical operation with complete dissection of the first and second group of lymph nodes (R2 resection) is a safe and appropriate treatment even for early gastric cancer. We propose that the definition of early gastric cancer be modified to ‘carcinoma with invasion confined to the mucosa or submucosa and without evidence of lymph node metastases’.</jats:p>