Lymph node metastasis from intestinal-type early gastric cancer: experience in a single institution and reassessment of the extended criteria for endoscopic submucosal dissection
View/ Open
Lauwers_LymphNode.pdf (1.300Mb)
Access Status
Full text of the requested work is not available in DASH at this time ("restricted access"). For more information on restricted deposits, see our FAQ.Author
Kang, Hyun Jeong
Jeon, Tae-Yong
Lee, Soo-Han
Shin, Nari
Chae, Sue-Hye
Kim, Gwang Ha
Song, Geum Am
Kim, Dong-Heon
Park, Do Youn
Note: Order does not necessarily reflect citation order of authors.
Published Version
https://doi.org/10.1016/j.gie.2010.03.1077Metadata
Show full item recordCitation
Kang, Hyun Jeong, Dae Hwan Kim, Tae-Yong Jeon, Soo-Han Lee, Nari Shin, Sue-Hye Chae, Gwang Ha Kim, et al. 2010. “Lymph Node Metastasis from Intestinal-Type Early Gastric Cancer: Experience in a Single Institution and Reassessment of the Extended Criteria for Endoscopic Submucosal Dissection.” Gastrointestinal Endoscopy 72 (3) (September): 508–515. doi:10.1016/j.gie.2010.03.1077.Abstract
BACKGROUND:Given the increasing use of endoscopic resection as a therapeutic modality for cases of early gastric cancer (EGC), it is very important to define strict criteria for the use of endoscopic mucosal resection and endoscopic submucosal dissection. To date, the criteria are almost entirely based on Japanese literature evaluating the risk of lymph node (LN) metastasis in patients with EGC.
OBJECTIVE:
To analyze our own experience with the factors affecting LN metastasis and to reappraise the extended criteria for endoscopic submucosal dissection.
DESIGN:
Retrospective, single-center study.
SETTING:
University teaching hospital.
PATIENTS:
This study involved 478 patients who underwent gastrectomy with LN dissection (n = 270, mucosal [m] EGC; n = 208, submucosal [sm] EGC).
INTERVENTION:
Gastrectomy with LN dissection.
MAIN OUTCOME MEASUREMENTS:
LN metastasis.
RESULTS:
Overall, 12.6% (60/478) of patients with EGCs presented with LN metastasis (mEGC, 3.0% [8/270], smEGC, 25.0% [52/208]). Increased size, macroscopic type (elevated), depth of invasion, and lymphovascular invasion were associated with LN metastasis. In 270 cases of mEGC, there was no relationship between clinicopathologic features and LN metastasis. In the smEGC group, size, depth of invasion, and lymphovascular emboli were associated with an increased risk of LN metastasis. Significantly, LN metastasis was noted in EGCs falling within established extended endoscopic submucosal dissection criteria, that is, intestinal-type mucosal cancer of any size without ulcer and no lymphovascular emboli (2/146 [1.4%]) or < or =3 cm with no lymphovascular emboli and irrespective of the presence of ulceration (2/126 [1.6%]) or intestinal-type submucosal cancer (sm1, <500 microm) without lymphovascular invasion and measuring < or =3 cm in size (3/20 [15.0%]).
LIMITATIONS:
Retrospective review of a single-center study.
CONCLUSION:
We recommend that more centers survey their experiences of LN metastasis in cases of EGC to refine the criteria for endoscopic submucosal dissection as a therapeutic modality of intestinal-type EGC.
Citable link to this page
http://nrs.harvard.edu/urn-3:HUL.InstRepos:35136067
Collections
- HMS Scholarly Articles [17852]
Contact administrator regarding this item (to report mistakes or request changes)