Precision surgical approach with lymph-node dissection in early gastric cancer

Table 1 Summary of representative literature on the precise incidence of nodal metastasis in early gastric cancer

Nodal location	Total cases	Perigastric nodes (%)						aLGA (%)	Suprapancreatic nodes (%)				SpH (%)	aPHA (%)	PAN (%)
Station NO		1	2	3	4	5	6	7	8a	9	11p	11d	10	12a	16
Kitamura et al[23]	634	8.2						1.6	0.94	0.31	0.31	0.00	0.00	0.16	0.16
Tanaka et al[24]	2368	0.97	0.08	4.6	3.2	0.51	2.4	1.4	0.63	0.72	0.42	0.00	0.00	0.00	0.00
Nakajima et al[25]	3630	0.90	0.11	5.9	3.9	0.47	3.4	1.1	1.1	1.1	0.36	0.03	0.08	0.06	0.25
Yoshikawa et al[26]1	7151	19.01						2.01	1.81	0.131	0.131	0.001	0.001	0.001	0.001

¹Study of submucosal cancer. Percentages represent proportion of patients with metastasis in lymph nodes of given station. All articles but Yoshikawa include both mucosal cancer and submucosal cancer; Yoshikawa includes only submucosal cancer cases. aLGA: Nodes along left gastric artery; SpH: Nodes at the hilum of spleen; aPHA: Nodes along hepatic artery proper; PAN: Paraaortic nodes.

Table 2 Updated preoperative indications for endoscopic submucosal dissection in Japanese gastric cancer treatment guidelines 2018

Depth of invasion (preoperative)	Clinical mucosal cancer
Intra-tumoral ulcer of ulcer scar	UL 0		UL 1
Tumor size (Long axis)	2 cm	> 2 cm	3 cm	> 3 cm
Differentiated	A	B	B	D
Undifferentiated	C	D	D	D

A: Absolute indication for both endoscopic mucosal resection and endoscopic submucosal dissection; B: Absolute indication for endoscopic submucosal dissection; C: Expanded indication for endoscopic submucosal dissection; D: Relative indication (Alternative).

Table 3 Updated evaluation of curability after endoscopic submucosal dissection in Japanese gastric cancer treatment guidelines 2018

Updated evaluation of curability after endoscopic submucosal dissection
eCuraA	En-bloc resection, predominantly differentiated adenocarcinoma, pathological mucosal cancer (pT1a), HM0, VM0, Ly0, V0
	UL0 (regardless of size)
	UL1, under 3 cm in diameter
	If size of undifferentiated component is > 2 cm, tumor is diagnosed as eCuraC-2
eCuraB	En-bloc resection, HM0, VM0, Ly0, V0
	UL0, under 2 cm in diameter, predominantly undifferentiated adenocarcinoma, pathological mucosal cancer (pT1a)
	UL1, under 3 cm in diameter, predominantly differentiated adenocarcinoma, pathological submucosal cancer within 500 µm (pT1b1)
	If there is an undifferentiated component in the submucosal layer, tumor is diagnosed as eCuraC-2
eCuraC-1	Lesion meeting criteria of eCuraA or eCuraB except with positive lateral margin or non–en-bloc resection.
eCuraC-2	The lesion meets none of eCuraA, eCuraB, or eCuraC-1