Optimum Extent of Lymph Node Dissection in the Surgical Treatment of Gastric Cancer Accompanied by Liver Cirrhosis

Hiroshi Isozaki, Kunio Okajima, Yasuo Kawashima, Shinichi Yamada, Shinsho Morita, Tatsuhiro Nakajima, Eiji Nakata, Chihiro Iga, Takashi Ishibashi, Masakazu Tanimura, Hitoshi Hara

Department of Surgery, Osaka Medical College

To clarify the optimum extent of lymph node dissection in the surgical treatment of gastric cancer accompanied by liver cirrhosis, we recently analyzed the results of preoperative examinations, intraoperative findings and extent of lymph node dissection in relation to postoperative complications in 28 cases of cirrhosisaccompanied gastric cancer. The following results were obtained. 1. The incidence of postoperative complication was as high as 71% (28% for severe complications). 2. Factors associated with the high incidence of severe complications include Child C, preoperative serum GOT over 80 U/l, bilirubin over 1.1 mgldl, albumin below 3.0 g/dl and ICG R₁₅ over 35%. 3. The incidence of severe complications was high in cases where intraperitoneal venous dilation was found during the operation. 4. In cases accompanied by severe liver cirrhosis, complications occurred even when the extent of lymph node dissection was limited. 5. In cases showing intraperitoneal venous dilation, No. 12 lymph node dissection increased the risk of severe complications and the mortality rate. 6. The five-year postoperative survival rates were 56% for early cancer and 14% for advanced cancer. Patients frequently died of hepatoma or liver failure. These results indicate that both the stage of gastric cancer and the status of liver cirrhosis should be considered in surgical treatment of cirrhosis-accompanied gastric cancer, and that lymph node dissection should be minimized in such cases.

Key words
gastric cancer accompanied by liver cirrhosis, lymph node dissection for gastric cancer, postoperative complications of gastric cancer

Reprint requests
Hiroshi Isozaki Department of Surgery, Osaka Medical College
2-7 Daigaku-machi, Takatsuki, Osaka, 569 JAPAN

Accepted
October 11, 1990

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