A Study on Lymph Nodes Metastases Along the Splenic Artery of Gastric Cancer

Shinji Okano, Kiyoshi Sawai, Masahide Yamaguchi, Kosuke Seiki, Hiroki Taniguchi, Akeo Hagiwara, Toshiharu Yamaguchi, Toshio Takahashi

First Department of Surgery, Kyoto Prefectural University of Medicine

Aiming at improving the prognosis for patients with metastases of gastric cancer in the lymph nodes along the splenic artery (No. 11), we examined the records of 541 patients with gastric cancer lymph node metastases operated on in our institute. When the patients with cancer in the upper or middle third of the stomach had metastases in the right cardial lymph nodes, the lymph nodes along the short gastric artery, along the left gastroepiploic artery, along the left gastric artery or along the common hepatic artery, the rate of metastasis to the No. 11 lymph nodes was very high. Consequently, for these patients we recommented total gastrectomy with distal pancreatico-splenectomy for complete removal of No. 11 lymph nodes. When the patients with cancer in the lower third of the stomach had metastases in the infrapyloric lymph nodes and/or lymph nodes along the superior mesenteric artery, the rate of metastasis to the No. 11 lymph nodes was also very high. In these patients, as many lymph nodes along the splenic artery should be removed as possible. The rate of para-aortic lymph node (No. 16) metastasis was higher in the patients with metastases in No. 11 nodes than in those without them. This fact indicates that there was much lymphatic drainage from No. 11 to No. 16. When the metastatic grade of lymph nodes was the same, the survival rate for the patients with No. 11 metastases was significantly lower than that for the patients without them. We concluded that one of the reasons for the poor outcome for the patients with No. 11 metastases was incomplete dissection of No. 11 and No. 16 lymph nodes.

Key words
lymph node metastases of the stomach cancer, lymph nodes along the splenic artery, paraaortic lymph node metastases of the stomach cancer

Reprint requests
Shinji Okano The First Department of Surgery, Kyoto Prefectural University of Medicine
465 Kajiimachi, Kawaramachi-dori Hirokoji-agaru, Kamigyo-ku, Kyoto, 602 JAPAN

Accepted
April 1, 1992

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