OBJECTIVETo explore the pattern of lymph node metastasis and to determine a rational approach of surgery for early gastric cancer (EGC).

METHODSBetween January 1994 and January 2008, 165 patients with EGC were given D2 or over dissection. Clinicopathologic data of this group was analyzed retrospectively.

RESULTSThe lymph node metastasis rate was 3.8% in mucosa carcinoma (m-carcinoma), and was limited in first-tier; it was 25.7% in submucosa carcinoma (sm-carcinoma) and metastasized to second-tier and third-tier. Lymph node metastasis rate of EGC in u-region was low and was only limited in first-tier. But, in L-region, second- and third-tier lymph node metastasis was found in 5.2% and 0.9% of the patients, respectively. Second-tier lymph node metastasis was found in No. 7, 8, 9 and third-tier in No. 12, 14V, 16. The tumor size and lymph node metastasis was related closely, the lymph node metastasis only involved first-tier in m-carcinoma with a diameter < 5 cm, but the second-tier was involved in all sm-carcinoma. Significant difference was found in survival depending on the grade of tumor invasion: the cumulative 5-year survival rate was 97.3% in the m-carcinoma and was 87.6% in the sm-carcinoma (P = 0.019). There was no significant difference in survival between the extents in lymph node dissection (D2 93.8%, D3 91.7%) (P = 0.677).

CONCLUSIONSD2 and D2+ lymph node dissection is necessary for sm-early gastric cancer. A less radical approach could be applied to m-early gastric cancer in the u-region with a diameter < 2 cm.