Degree of Submucosal Invasion of Early Gastric Carcinomas and Risk for Lymph Node Metastasis: Consideration Limiting of Applicability for Endoscopic Resection Kazuhiko Omote 1 , Masayoshi Mai 1 , Masayuki Mizoguchi 1 , Yutaka Takahashi 1 , Atsuhiro Kawashima 2 1Department of Surgery, Cancer Research Institute, Kanazawa University 2Department of Surgical Pathology, Cancer Research Institute, Kanazawa University Keyword: 胃sm癌 , sm細分類 , リンパ節転移 , 内視鏡的切除 pp.49-55
Published Date 1997/1/25
DOI https://doi.org/10.11477/mf.1403104951
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 Classifying 235 cases of submucosal (sm) carcinoma of the stomach according to the degree of sm invasion, we considered their applicability for endoscopic resection. The degree of sm invasion was designated as follows: sm1-α; depth of the invasion was limited within the first 300 μm of the sm layer, sm1-β; the invasion was limited within 300 μm ~ 1/3 of the sm layer, sm2; the invasion reached from 1/3 to 2/3 of the sm layer, sm3; carcinoma invaded close to the proper muscle layer. Histopathologically, all the specimens were examined to evaluate the risk for lymph node metastasis. On analysis of the degree of carcinomatous invasion into the sm layer, the positive rate of lymph node metastasis in sm1-α was 6.3%, and rates in sm1-β, sm2 and sm3 were 16.7%, 15.1% and 22.7% respectively. Histopathologic correlations with the risk for lymph node metastasis were observed in degree of sm invasion, tumor size, histologic type of the invasive front, lymphatic permeation and coexistance of ulceration. However, there were no lymph node metastases with the lesions of sm1-α measuring 30 mm or less in size, sm1-β and sm2 measuring 10 mm or less in size. In addition, if the sm1-β lesions measuring 30 mm or less in size were accompanied with well differentiated adenocarcinoma at the invasive front or without lymphatic permeation or ulceration, they also had no lymph node metastasis. Consideration of the risk for lymph node metastasis indicated that only the sm invasive carcinomas of the stomach without lymph node metastasis should be treated by endoscopic resection or laparoscopic local excision. It was thus suggested in this study that the lesions which seem to have no lymph node metastasis as described above can be cured with endoscopic therapy.

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