Surgical Outcome in Superficially Spreading Early Gastric Cancer

Abstract

Objectives: Superficially spreading early gastric cancer is characterized by wide horizontal extension without deep vertical invasion. This study aimed to clarify the clinicopathological characteristics and prognosis of this rare disease. Methods: We defined superficially spreading early gastric cancer as any tumor invading the submucosal layer that measured ≧60 mm in diameter. The clinicopathological characteristics and results of surgery were compared between 60 patients with superficially spreading tumors and 621 patients with the common type (<60 mm in diameter). Results: Forsuperficially spreading cancers,significantly higher numbers of female patients, undifferentiated and scirrhous types, infiltrating growth and lymph node metastases were seen. The number of metastatic lymph nodes was greater than in the common type. There was no significant difference in the distribution of metastatic lymph nodes between the two groups. For superficially spreading tumors, wide gastrectomy with extended lymph node dissection was frequently employed. Lymph node metastasis, but not tumor diameter, was a prognostic factor in uni- and multivariate analyses. Conclusions:Although superficially spreading early gastric cancer has histologically distinct properties, gastrectomy with lymph node dissection with sufficient surgical margin could be a suitable treatment.

Clinicopathological Properties of the Superficial Spreading Type Early Gastric Cancer

“…Previous studies have reported that the superficial spreading type accounted for 5.46% to 11.0% of all EGC, [8][9][10][11] and the incidence of lymph node metastasis in the superficial spreading type of EGC was 20.3% to 30.0%. 8,9 Our results were also almost compatible with these previous reports.…”

“…21 Furthermore, Kunisaki et al reported that the number of metastatic lymph nodes was greater in the superficial spreading type of EGC than in the common tumor type. 10 Recurrence of EGC was shown to be significantly higher in the patient group with submucosal, node-positive, and undifferentiated tumors. 1,3 Sufficient resection margins are necessary to prevent the reappearance of EGC as inadequate resections that do not maintain surgical margins free of cancer can lead to disease recurrence.…”

Investigation of Endoscopic and Pathologic Features for Safe Endoscopic Treatment of Superficial Spreading Early Gastric Cancer

“…The rate of superficial spreading EGC is low, ∼6.5% to 11.0% of all EGC cases, 15–18 whereas the incidence of lymph node metastasis in superficial spreading EGC ranges from 18% to 30%. 15,16,18 In our study, superficial spreading EGC accounted for 3.7% of all EGC cases, with a lymph node metastasis rate of 15.7%. The overall prognoses of the superficial spreading and common types of EGC appear to be similar.…”

“…15 Although superficial spreading is typical of this type of EGC, the pathophysiology of this feature has not been elucidated. Similarly, the mechanism by which the invasion depth is limited has not been identified.…”