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Additive lymph node dissection may be necessary in minute submucosal cancer of the stomach after endoscopic resection

 Kim, Jie-Hyun  ;  Lee, Yong Chan  ;  Kim, Hyunki  ;  Yoon, Sun Och  ;  Kim, Hoguen 
 ANNALS OF SURGICAL ONCOLOGY, Vol.19(3) : 779-785, 2012 
Journal Title
Issue Date
Adenocarcinoma/pathology* ; Adenocarcinoma/surgery* ; Biomarkers, Tumor/analysis ; Cytoskeletal Proteins/analysis ; Female ; GTPase-Activating Proteins/analysis ; Gastroscopy* ; Humans ; Immunohistochemistry ; Lymph Node Excision* ; Lymphatic Metastasis/diagnosis ; Male ; Matrix Metalloproteinase 9/analysis ; Middle Aged ; Neoplasm Invasiveness ; Nuclear Proteins/analysis ; Risk Factors ; Stomach Neoplasms/pathology* ; Stomach Neoplasms/surgery* ; Vascular Endothelial Growth Factor C/analysis
Lymph Node Metastasis ; Early Gastric Cancer ; Endoscopic Resection ; Submucosal Layer ; Invasion Depth
PURPOSE: In early gastric cancer (EGC), minute submucosal (SM1) invasion of the stomach has been regarded as an expanded indication for endoscopic resection (ER). The exact prediction of SM1 invasion before ER may be difficult. Thus, SM1 invasion may be important to decide additive treatment after ER. This study was designed to investigate the incidence of lymph node metastasis (LNM) in SM1-EGC based on surgical specimens and to evaluate the factors that indicate additional treatment after ER. METHODS: From May 2005 to December 2008, 1,676 patients with EGC underwent surgery at Severance and Gangnam Severance Hospital, Seoul, Korea. Among them, 126 patients were diagnosed with differentiated SM1-EGC. The clinicopathologic characteristics were analyzed with respect to LNM and lymphovascular invasion (LVI), which is a known independent risk factor for LNM. Intratumoral marker immunohistochemistry was examined as a predictor of LVI. RESULTS: The mean SM1 invasion depth was 621.3 ± 745.6 μm. The LNM rates did not differ significantly between differentiated SM1-EGC (6.3%) and SM1-EGC (4.1%) meeting the expanded indication for ER. Female gender, moderate differentiation, LVI, and LVI grade were positively correlated with LNM. Female gender and elevated lesion morphology were associated with LVI. The expression levels of VEGF-C and OPHN1 were higher in LVI-positive tissues. CONCLUSIONS: The LNM rate in differentiated SM1-EGC meeting the expanded ER criteria was 4.1% in the present study, indicating that additional lymph node dissection may be necessary after ER in some cases of SM1-EGC.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
Kim, Hyunki(김현기) ORCID logo https://orcid.org/0000-0003-2292-5584
Kim, Ho Keun(김호근)
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Park, Hyo Jin(박효진) ORCID logo https://orcid.org/0000-0003-4814-8330
Yoon, Sun Och(윤선옥) ORCID logo https://orcid.org/0000-0002-5115-1402
Youn, Young Hoon(윤영훈) ORCID logo https://orcid.org/0000-0002-0071-229X
Lee, Sang In(이상인)
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Choi, Seung Ho(최승호) ORCID logo https://orcid.org/0000-0002-9872-3594
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