Studies on Clinical Features and Reasonable Lymph Node Dissection of Cancer in Upper Stomach from the Viewpoint of Histological Form of Esophageal Invasion

Kuniyoshi Arai, Masatsugu Kitamura, Kaoru Miyashita

Department of Surgery, Tokyo Metropolitan Komagome Hospital

Forty-eight cases of cancer in upper stomach with esophageal invasion were classified as expansive type or infiltrative type from the histological form of the invasion, and studied according to each clinical feature. The macroscopic type of the main lesion in the expansive type was mostly Borrmann type 1 or 2, and in the infiltrative type, Borrmann type 3 or 4. The latter showed a statistically high non-curative resection rate (67.9%). The rate of metastasis to the mediastinal lymph node was 10.0% for the expansive type and 46.4% for the infiltrative type, while the rate of metastasis to the paraesophageal and diaphragmatic lymph node (No. 110, 111) was very similar to that of the lymph nodes around the celiac artery (No. 9) or the common hepatic artery (No. 8). The outcome for the inifltrative type was poorer than that for the expansive type because of the lower curative resection rate, but in curative cases there was no significance between them. In conclusion, dissection of the mediastinal lymph node is not useful in non-curative cases of the infiltrative type because the cause of death is mainly carcinomatous peritonitis. However, in curative cases laparo-phreno-thoracotomy or laparo-phreno-sternotomy should be performed for cancer in upper stomach with esophageal invasion.

Key words
histological form of esophageal invasion, mediastinal lymph node dissection for cancer in upper stomach, laparo-phreno-sternotomy

Reprint requests
Kuniyoshi Arai Department of Surgery, Tokyo Metropolitan Kamagome Hospital
3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113 JAPAN

Accepted
March 7, 1990

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