Editorial
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 21, 2009; 15(19): 2309-2313
Published online May 21, 2009. doi: 10.3748/wjg.15.2309
Clinicopathological features of early gastric cancer with duodenal invasion
Tsutomu Namikawa, Kazuhiro Hanazaki
Tsutomu Namikawa, Kazuhiro Hanazaki, Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku-City, Kochi 783-8505, Japan
Author contributions: Namikawa T analyzed the data and wrote the paper; Hanazaki K carried out all the manuscript corrections.
Correspondence to: Kazuhiro Hanazaki, Professor, Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku-City, Kochi 783-8505, Japan. hanazaki@kochi-u.ac.jp
Telephone: +81-88-8802370
Fax: +81-88-8802371
Received: February 12, 2009
Revised: February 27, 2009
Accepted: March 6, 2009
Published online: May 21, 2009
Abstract

The incidence of early gastric cancer (EGC) with duodenal invasion is extremely low, although advanced gastric cancer that arises in the antrum occasionally invades the duodenum. We investigated the clinicopathological features of EGC with duodenal invasion and provided strategies for clinical management. A Medline search was performed using the keyword “early gastric cancer” and “duodenal invasion”. Additional articles were obtained from references within the papers identified by the Medline search. We revealed that EGC with duodenal invasion was of the superficial spreading type of tumor. Tumors > 60 mm in size invaded the duodenum more extensively, and the distance of duodenal invasion from the pyloric ring was further in the elevated type than in the depressed type of tumor. There was no significant difference between the length of duodenal invasion and the histological type of the tumor. Gastric cancer located adjacent to the pyloric ring, even if cancer invasion was confined to the mucosa or submucosa, was more likely to invade the duodenum. The present study reveals that the elevated type of EGC is associated with more extensive duodenal invasion when the tumor size is > 60 mm, thus highlighting the importance of identification of duodenal invasion in these cases. We also reveal that sufficient duodenal resection with a cancer-free distal surgical margin should be performed in cases of duodenal invasion.

Keywords: Duodenal invasion; Early gastric cancer; Gastrectomy; Superficial spreading type; Tumor differentiation