The Risk of Lymph Node Metastasis in Early Gastric Cancer Conforming to Indications of Endoscopic Resection and Pylorus-Preserving Gastrectomy: A Single-Center Retrospective Study

Background: Lymph node metastasis (LNM) status is an important prognostic factor that strongly influences the treatment decision of early gastric cancer (EGC). This study aimed to evaluate the pattern and clinical significance of LNM in EGC.Methods: Patients with EGC who underwent radical gastrectomy were enrolled. Their clinicopathological features, pathological reports, and prognostic data were collected and analyzed.Results: Three hundred fifty-four patients with EGC were enrolled. The incidence of LNM in patients with EGC was 18.36% (65/354). The rates of D1 and D2 station metastases were 12.1% (43/354) and 6.214% (22/354), respectively. The rates of LNM in absolute indication of endoscopic resection and expanded indication were 3.27% (2/61) and 28.55% (4/14), respectively. Skip LNM was observed in 3.67% (13/354) of patients. For those with middle-third EGC, the metastasis rate of the No. 5 lymph node was 3.05% (5/164). The independent risk factors for LNM were tumors measuring >30 mm, poorly differentiated tumors, and lymphovascular invasion (all P < 0.05，area under the curve = 0.783). Five-year disease-free survival rates of patients with EGC with and without LNM were 96.26% and 79.17%, respectively (P = 0.011). Tumors measuring >20 mm and LNM were independent predictive factors for poor survival outcome in patients with EGC.Conclusions: Patients with EGC conforming to expanded indications have a relatively high risk of LNM and may not be suitable for endoscopic submucosal dissection. Pylorus-preserving gastrectomy for patients with middle-third EGC remains controversial due to the high metastasis rate of the No. 5 lymph node.