Clinicopathological Characteristics of Cases with Metastasis to Lower Mediastinal Lymph Nodes and Treatment in Gastric Cancer with Esophageal Invasion

Masatsugu Kitamura, Kuniyoshi Arai, Kaoru Miyashita

Department of Surgery, Tokyo Metropolitan Komagome Hospital

A total of 111 gastric cancer patients with esophageal invasion who had undergone either laparosternophrenotomy or left thoraco-laparotomy were studied to evaluate the actual state of lower mediastinal lymph node metastasis and related clinicopathologic characteristics. The patients with positive lymph node metastasis (26 cases) in the lower mediastinal area had larger tumors, a higher rate of peritoneal dissemination (42%) (p<0.01), and were cases of type 3 and 4 than the negative lymph node metastasis gfoup (85 cases). The former group also has more noncurative resections (77%) (p<0.01), a higher incidence of n₃ (+) and n₄ (+), more undifferentiated tumors (p<0.01), a significantly higher incidence (p<0.05) of ow (+) and significantly longer distance (p<0.05) of esophageal invasion. The rate of metastasis in the lower mediastnal lymph nodes were 22.5% for No. 110, 13.4% for No. 111, and 10.3% for No. 112, or 23.4% overall. The rate of metastasis rose in proportion to increase in tumor diameter and length of esophageal invasion and was directly proportional to the extent of metastasis in the abdominal cavity and related depth of cancer. The positive group was characterized by a particularly high 16a-2 latero metastasis. The outcome was significantly worse in the patients with lower mediastinal metastasis than in those without it. Nonetheless, a relatively good prognosis even for positive metastatic cases may be achieved by systemic lymphadenectomy in the lower mediastinum and para-aortic extirpation along with ow (-), provided that the intra-abdominal procedure is curative.

Key words
prognosis of gastric cancer with esophageal invasion, metastatatic rate of lower mediastinal lymph node, lymph node dissection of lower mediastinum

Reprint requests
Masatsugu Kitamura Department of Surgery, Tokyo Metropolitan Komagome Hospital
3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113 JAPAN

Accepted
June 17, 1992

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