A Pathological Study of the Indication for Para-aortic Lymph Node Dissection in Advanced Gastric Cancer

Masataka Segawa, Yutaka Yonemura, Hisashi Matsumoto, Hironobu Kimura, Touru Kamata, Takashi Fujimura, Shigekazu Ooymama, Kazuo Sugiyama, Genichi Nishimura, Takeo Kosaka, Akio Yamaguchi, Kouichi Miwa, Itsuo Miyazaki

Department of Surgery II, School of Medicine, Kanazawa University

87 cases of advanced gastric cancer were reviewed to find the answer to whether para-aortic lymph node dissection R4-lymphadenectomy) improved the prognosis in patients with advanced gastric cancer and to determine the indications for R4-lymphadenectomy. 24 cases of the 87 cases were found to be n4. In 11 cases of n4 cases not judged N4, micrometastasis was found in the No. 16 lymph node. In all 24 cases (n4 cases), metastasis was frequent in group 2 lymph nodes, especially Nos. 7, 9, 10, and 11. Furthermore, by measeuring the depth of cancerous invasion, the rate of positivity of prognostic serosal factor (ps (+)) in the n4 cases was found to be 79%, which was higher than that in non n4 cases (p<0.01). It is difficult to diagnose to be n4 during the operation, but it may be concluded that in cases of advanced gastric cancer diagnosed as ps (+) or with metastasis to group 2 lymph nodes, R4-lymph-adenectomy should be performed to remove micrometastsis in No. 16.

Key words
R₄-lymphadenectomy, metastasis of para-aortic lymph node in advanced gastric cancer

Reprint requests
Masataka Segawa Department of Surgery II, School of Medicine, Kanazawa University
13-l Takara-machi, Kanazawa, 920 JAPAN

Accepted
April 11, 1990

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