Abstract

From 1980 through 1991, 17Z9 patients underwent operation for gastric cancer at Department of Surgery, Catholic University Medical College in Seoul, Korea. Three hundred and twelve patients (18.0%) were early gastric cancer (EGC): mucosal cancer were 107 cases (34.3%) and submucosa1 cancer were 205 cases (65.7%). The purpose of the present study was to compare the clinicopathologic features of EGC between mucosal cancer and submucosal cancer. Submucosal cancer developed in older age than mucosal cancer (average 55 vs 49 years old). No differences, however, were noted in clinical manifestations and duration of symptoms. Macroscopically, elevated lesions (type I or IIa predominant) were frequently encountered in submucosal cancer than mucosal cancer (24.6 vs 9.7%). Histologically, differentiated carcinoma or intestinal type by Lauren's classification was more common in submucosal cancer than mucosal cancer. The incidence of lymph node metastasis of EGC was 15.1% (47/312): 2.8% (3/ 107) in mucosal cancer and 21.5% (44/205) in submucosal cancer. Lymph node involvement of submucosal cancer was significantly higher in patients with elevated lesions (35.3%) than in depressed lesions (13.5%). No lymphatic or venous invasion was noted in mucosal cancer. In submucosal cancer, however, incidence of venous and lymphatic invasion was 7.2% and 20.3%, respectively. Kaplan-Meier estimates for 5-year survival were 98% for mucosal lesions and 79% for submucosal lesions (overall 5-year survival rate; 86.3%). The Syear survival rate in patients of submucosal cancer with lymph node metastasis was only 60% comyared with 88.5% in pa- tients of submucosal cancer without lymph node involvement. All recurrent cases were submucosal cancer patients. Six out of the 9 recurrent patients were macroscopically elevated type and had lymph nade metastasis. The authors conclude that there is definite difference in terms of clinicopathologic findings between mucosal and submucosal cancer of stomach even though EGC includes both lesions by definition. So, therapeutic approach of submucosal cancer should be different from mucosal cancer.

• Keywords: Early gastric cancer (EGC), Clinicopathologic differences