《Table 3 Updated evaluation of curability after endoscopic submucosal dissection in Japanese gastric

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

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Early gastric cancer is defined as carcinoma in which depth of invasion is restricted to the mucosal layer or submucosa[11].The presence or absence of lymph-node metastasis is irrelevant to the classification[11].Most early gastric cancers are asymptomatic.Early gastric cancer is often detected with gastroscopy or barium meal during a healthscreening checkup[12].Advanced gastric cancer is frequently associated with hematogenous or peritoneal metastases，while in contrast，early gastric cancer has few such distant metastases.On the other hand，early gastric cancer is rarely associated with lymph-node metastasis.The frequency of lymph-node metastasis is 2%-3%in mucosal cancer and 15%-20%in submucosal cancer[13-21].Numerous previous studies have examined the location of these lymph node metastases.In the classification of gastric carcinoma of the Japanese Gastric Cancer Association[22]，the regional lymph nodes of the stomach are classified in detail and numbered.Currently，the extent of lymph-node metastasis has been evaluated in terms of the number of metastases，but in the past，regional nodes were grouped according to the location of the cancer，and the degree of lymph-node metastasis was evaluated based on which group of nodes the metastasis had reached.The precise data of nodal metastasis of early gastric cancer described in a representative literature are summarized in Table 1[23-26].Most nodal metastasis in early gastric cancer was found to be limited to perigastric nodes and nodes number 7，8a，and 9.Based on these results，the Japanese Gastric Cancer Association established D1+[27]，the extent of lymph-node dissection for submucosal cancer（Figure 1）.The disease-specific survival of D1+gastrectomy for early gastric cancer is often given as 96%-98%in articles investigating the outcome of laparoscopic gastrectomy[28-30].