Abstract
Recent advances in the development of molecular diagnostic tools have improved the detection of lymph node micrometastasis (LNM) in patients with gastric cancer. Isolated or micrometastatic tumor cells are also heterogeneously distributed in lymph nodes. Since the incidence of LNM in patients with early gastric cancer (pT1) ranges between 10% and 31.8%, even patients with early gastric cancer are at a high risk of developing LNM. Moreover, the incidence of LNM is slightly higher in patients with advanced gastric cancer than in those with early gastric cancer. A close relationship has been reported between LNM and lymphatic invasion in primary tumors. The clinical impact of LNM currently remains controversial in patients with gastric cancer. Therefore, it is clinically difficult to reach concrete conclusions regarding the prognostic significance of LNM. However, the rate of positivity for Ki-67 in LNM was previously reported to be between 92.0% and 94.2%. Consequently, tumor cells within LNM exhibit high proliferative activity. In clinical management, therapeutic strategies for LNM need to be planned in order to avoid lymph node recurrence. It is considered important to preserve the balance between quality of life and curability when selecting minimally invasive surgery, such as sentinel node navigation _surgery and endoscopic submucosal dissection, for patients with early gastric cancer. This chapter will focus on the clinical aspect of LNM in patients with gastric cancer.
Published Version
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