Choice of the surgical treatment in early gastric cancer

Background/Aims: The authors report their experience in choosing the surgical treatment for early gastric cancer. Methodology: A retrospective study was conducted to examine the long-term outcome of 18 patients with early gastric cancer (10%) on a series of 180 patients treated for gastric carcinoma by the same surgical equipe from January 1986 to June 1997. Radical surgery with gastrectomy and extended lymphadenectomy ("regional" from 1986 to 1991; D2 from 1992 to 1997) was chosen as standard treatment for early gastric cancer except in elderly or high-risk patients and in cases of mucosal tumors diagnosed at definitive histology after surgery for benign diseases in which limited surgery was performed. Results: All patients received curative (R0) surgery. One patient with mucosal-N1 tumor and another one with submucosal-NO tumor died because of gastric cancer at 51 and 42 postoperative months respectively. The mean follow-up time was 99.8 (11-193) months. The overall 5-year and 10-year survival rates are 86.7% and 86.7% respectively. The 5- and 10-year survival rates for intramucosal tumors are 91% and 91% respectively and for submucosal cancer are 75% and 75% (P = 0.39). Conclusions: According to the prognostic value of nodal involvement and the difficulty in achieving a preoperative accurate diagnosis of depth of invasion and of nodal involvement in early gastric cancer, a radical gastric resection with D2-lymphadenectomy should be performed.