Risk factors for lymph node metastasis in histologically poorly differentiated type early gastric cancer

Kunisaki, Chikara; Takahashi, Mutsuo; Nagahori, Yutaka; Fukushima, Tadao; Makino, Hirochika; Takagawa, Ryo; Kubo, Takashi; Ha, Ono; Akiyama, Hirotoshi; Moriwaki, Yoshihiro; Nakano, Akira

doi:10.1055/s-0029-1214758

Cited by 60 publications

(48 citation statements)

References 21 publications

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“…Similar findings were observed in our previous work, a Korean study performed by another group, and two Japanese studies [9,10,14,16]. These observations suggest that in undifferentiated EGC, the risk of lymph node metastasis depends more on submucosal invasion and lymphovascular invasion than it does on histologic subtype, such as poorly differentiated or signet ring cell type.…”

Section: Discussionsupporting

confidence: 90%

“…Other studies have reported tumor length cutoff values for only one histologic subtype or for the united undifferentiated type. Kunisaki et al [16] proposed a cutoff length of 20 mm in poorly differentiated EGC with mucosal invasion but without lymphovascular invasion, and Park et al [21] and Li et al [22] proposed cutoffs of 15 and 20 mm, respectively, in poorly differentiated EGC. For signet ring cell EGC, Ha et al [14] and Park et al [15] proposed 20 and 25 mm as cutoff lengths, respectively.…”

Section: \00001mentioning

confidence: 99%

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Early gastric cancer of signet ring cell carcinoma is more amenable to endoscopic treatment than is early gastric cancer of poorly differentiated tubular adenocarcinoma in select tumor conditions

et al. 2011

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Section: Discussionsupporting

confidence: 90%

Section: \00001mentioning

confidence: 99%

Early gastric cancer of signet ring cell carcinoma is more amenable to endoscopic treatment than is early gastric cancer of poorly differentiated tubular adenocarcinoma in select tumor conditions

et al. 2011

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“…There have been several reports showing indications for endoscopic treatment of EGC of the undifferentiated type in view of a minimal risk of lymph node metastasis, because most EGCs are cured by surgical gastrectomy with lymph node resection [7,8,9,10,11,12,13,14,15]. Gotoda et al [16] showed there were no lymph node metastases in the intramucosal lesions <20 mm in diameter and no ulceration findings in the study of 2,341 cases of undifferentiated carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection for Undifferentiated Early Gastric Cancer as the Expanded Indication Lesion

Kamada¹,

Tomatsuri²,

Yoshida³

2012

Digestion

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Background: Endoscopic submucosal dissection (ESD) has become the standard endoscopic treatment for early gastric cancer without lymph node metastasis. At present, undifferentiated type intramucosal cancers without ulcer findings <20 mm in size are often chosen as endoscopic treatment lesions for expanded indication. The purpose of this study was to examine the outcome of ESD treatment in undifferentiated carcinomas. Method: Forty-six patients who had undergone ESD from July 2002 until July 2010, where the final pathological diagnosis was undifferentiated carcinoma, were assessed for the en-bloc resection ratio, the accuracy rate of depth or extent of diagnosis and survival. Results: In endoscopic ultrasonography studies, the accuracy rate of mucosal lesions was 86%. The rate of en-bloc resection was 91% (42/46) and 5 cases had a positive margin. Four cases had a positive margin in cases of piecemeal resection. Five cases underwent additional surgery, and residual cancer was found in 1 case. There were 2 cases of perforation, 2 of delayed hemorrhage, and no cases of delayed perforation. One case died of multiple liver metastases and 1 died of hepatocellular carcinoma. After a maximum of 8 years, an average of 3.8 years of observation, including 7 cases who had undergone additional surgery, recurrence occurred in only 1 case of liver metastasis. Conclusion: In this study the lesions of undifferentiated adenocarcinoma, which were limited to the mucosa, <20 mm in diameter and had been completely resected, showed no recurrence and were indicated for endoscopic treatment.

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“…In addition, the pathological analyses of resected specimens have revealed that lymph node involvement is found in less than 20% of patients, and metastasis to the second tier lymph nodes is especially rare in patients with early gastric cancer in Japan (1)(2)(3)(4). Recently, sub-total or total gastrectomy with a reduced lymphadenectomy, depending on the clinical and surgical findings, has been recommended in the guidelines for treating gastric cancer edited by the Japanese Gastric Cancer Association (JGCA guidelines) (5).…”

Section: Introductionmentioning

confidence: 99%

Sentinel node navigation surgery attenuates the functional disorders in early gastric cancer

Yaguchi

Tsujimoto

Kumano³

et al. 2011

Oncol Rep

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Abstract. The purpose of this study was to evaluate the merits of the sentinel node (SN)-navigated reduced gastrectomy (SNRG) procedure. The subjects (sT1N0) were divided into the SNRG group (n=34) and the GL group, that consisted of patients which underwent gastrectomy according to the Japanese Gastric Cancer Association guidelines (n=33). We compared the area of the resected stomach and evaluated their body weight changes, and the results of a questionnaire survey about postoperative symptoms, and nutritional effects by blood tests administered at postoperative months (POM) 3, 6 and 12. The median area of the resected stomach was 104 cm 2 in the SNRG group vs. 192 cm 2 in the GL group. The body weight loss ratio was -5.9±5.8 vs.-9.3±4.1% at POM 3, and the henoglobin (g/dl) change rate was -1.1±7.9 vs. -6.4±6.5% at POM 12 in the SNRG and GL groups, respectively. There were no significant differences regarding the passage of food, reflux, the incidence of dumping syndrome, digestive and excretory function, or general condition and the satisfaction levels of the patients. In conclusion, SNRG has some advantages over GL in terms of postoperative disorders for at least one year after surgery, and is the recommended choice of a surgical procedure for early gastric cancer.

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Risk factors for lymph node metastasis in histologically poorly differentiated type early gastric cancer

Abstract: A histologically poorly differentiated type mucosal gastric cancer measuring less than 20 mm and without LVI may be a candidate for endoscopic resection. This result should be confirmed in a larger study with many patients.

Cited by 60 publications

References 21 publications

Early gastric cancer of signet ring cell carcinoma is more amenable to endoscopic treatment than is early gastric cancer of poorly differentiated tubular adenocarcinoma in select tumor conditions

Early gastric cancer of signet ring cell carcinoma is more amenable to endoscopic treatment than is early gastric cancer of poorly differentiated tubular adenocarcinoma in select tumor conditions

Endoscopic Submucosal Dissection for Undifferentiated Early Gastric Cancer as the Expanded Indication Lesion

Sentinel node navigation surgery attenuates the functional disorders in early gastric cancer

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