• Annals of surgery · Jan 2017

    Lymph Node Metastasis in Mucosal Gastric Cancer: Reappraisal of Expanded Indication of Endoscopic Submucosal Dissection.

    • Seung-Young Oh, Kyung-Goo Lee, Yun-Suhk Suh, Min A Kim, Seong-Ho Kong, Hyuk-Joon Lee, Woo Ho Kim, and Han-Kwang Yang.
    • *Department of Surgery, Seoul National University College of Medicine, Seoul, Korea †Department of Pathology, Seoul National University College of Medicine, Seoul, Korea ‡Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
    • Ann. Surg. 2017 Jan 1; 265 (1): 137-142.

    ObjectiveTo evaluate risk factors for lymph node (LN) metastasis in mucosal gastric cancer, particularly the effect of cellular differentiation, and implications for the indication of endoscopic submucosal dissection (ESD).Summary Background DataThe indication of ESD has been expanded to undifferentiated-type (UD-type) gastric cancer despite risk of LN metastasis.MethodsPatients who underwent radical gastrectomy for pT1a stage primary gastric adenocarcinoma between 2008 and 2012 were retrospectively analyzed. We evaluated risk factors of LN metastasis using univariate and multivariate analyses. Pathologic slides of primary tumor and metastatic LNs from LN positive patients were reviewed.ResultsA total of 1003 mucosal gastric cancer patients were enrolled, and mean number of retrieved LNs was 35.5. Eighteen (1.8%) among them had LN metastasis: 2 of the 502 differentiated-type (D-type) patients and 16 of the 501 UD-type patients (0.4% vs 3.2%, P < 0.001). Type of cellular differentiation was a significant risk factor for LN metastasis in univariate and multivariate analyses. Of 216 UD-type patients satisfying the expanded indication of ESD, 5 patients (2.3%) showed LN metastasis. Despite more aggressive clinical features such as larger size of tumor and more LN metastasis, the UD-type cancer showed a less invasion into the muscularis mucosae layer than the D-type cancer.ConclusionsBecause UD-type cancer is a risk factor for LN metastasis in mucosal gastric cancer, ESD cannot be concluded to be a better option than surgery in all UD-type cancer patients. Redefinition of the expanded indication of ESD is required.

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