Recurrence after surgery for early gastric cancer (EGC)

Fifty-three patients with a histologically confirmed gastric adenocarcinoma confined to the mucosa (T1m) or submucosa (T1sm) were treated surgically between 1979 and 1992. Total gastrectomy was performed in 40 and subtotal gastrectomy in 13 patients The overall incidence of lymph node (LN) metastasis was 9.4% (5/53); 7.5% for N1-level and 1.9% for N2-level. For T1m and T1sm cancers the incidence of nodal metastasis was 6.2% and 14.3% respectively. Two (2/49. 4.1%) patients died of recurrent disease and 9 from other causes. Tumour lesion was not found by pathologic examination of surgically resected specimens in 6 (11.3%) patients with small mucosal cancer microscopically confirmed preoperatively by endoscopic biopsy which obviously resulted in the complete lesion resection. Our results suggest that recurrence after surgical resection of EGC is rare. D1 resection is sufficient for a complete tumour resection (RO) in most EGC patients. D2 resection is rarely necessary and indicated only for patients with submucosal cancer and N2 disease.