Determination of nodal status and treatment in early gastric cancer

Background In view of its low associated risk of metastatic spread, early gastric cancer has an excellent prognosis. The basis for the choice of treatment is the risk of lymphogenous metastatic spread together with the individual surgical risk. Methods The data collected from 279 patients in whom, between 01/1982 and 12/2001, a gastric resection or gastrectomy was carried out for early gastric cancer at the Surgical Department of the University Hospital, Erlangen, were analysed. A number of macroscopic and histopathological factors were examined by univariate and multivariate analysis for their effect on lymphogenous metastatic spread. Results In 33 patients (11.8%), regional lymph-node metastases were confirmed histologically. The grade of malignancy (high-grade, relative risk 9.9), diameter (>20 mm, relative risk 5.0) and lymphatic invasion (relative risk 3.5) all demonstrated a significant independent influence on the occurrence of regional lymph-node metastases. Seventy-three patients were identified as a low-risk group, with a risk of lymphogenous metastatic spread of only 1%. Conclusions Well differentiated or moderately differentiated carcinomas having a diameter of less than 2 cm can be treated by local intervention, such as local excision or endoscopic removal, without any increase in risk, provided that the tumour is reliably removed without residual tumour (histologically confirmed R0). In the presence of an elevated surgical risk, the choice of treatment must be made on an individual basis.