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By analysing over 5,000 surgical cases, this study identified early gastric cancers with essentially zero risk of lymph node spread, defining the expanded criteria that allow endoscopic removal instead of gastrectomy.
Retrospective analysis of 5,265 patients who underwent gastrectomy with lymph node dissection for early gastric cancer at two Japanese centres, examining the incidence of nodal metastasis by depth, size, histology, ulceration and lymphovascular invasion.
No nodal metastases were found in differentiated intramucosal cancers without ulceration regardless of size, in ulcerated differentiated intramucosal cancers up to 3 cm, or in differentiated cancers with minute submucosal invasion up to 3 cm without lymphovascular invasion.
The expanded criteria for endoscopic submucosal dissection in Japanese and international guidelines derive from this analysis.