Journal
GASTRIC CANCER
Volume 15, Issue 2, Pages 221-225Publisher
SPRINGER
DOI: 10.1007/s10120-011-0111-8
Keywords
Early gastric cancer; Lymph node metastasis; Expanded criteria; ESD; SM1
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Currently in Japan, differentiated gastric submucosal invasive cancers < 500 mu m (SM1) with negative lymphovascular involvement are included in expanded pathological criteria for curative endoscopic treatment. This is based on a retrospective examination of surgical resection cases in which patients suitable for such expanded criteria were determined to have a negligible risk of lymph node metastasis. We performed endoscopic submucosal dissection on a 65-year-old male with early gastric cancer in April 2005, and pathology revealed a well-differentiated adenocarcinoma, 21 x 10 mm in size, SM1 invasion depth and negative lymphovascular invasion as well as tumor-free margins, so the case was diagnosed as a curative resection. This case, however, resulted in lymph node metastasis that was diagnosed by endoscopic ultrasonography with fine-needle aspiration biopsy in May 2009. Distal gastrectomy with D2 lymph node dissection was then performed, confirming lymph node metastasis from the original gastric cancer.
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