Evaluation of Lymph Node Dissection in Patients with Japanese Classification Stage IV Gastric Cancer

Yoshitaka Yamamura, Tsuyoshi Kito, Junichi Sakamoto, Takashi Hirai, Kenzo Yasui, Takeshi Morimoto, Tomoyuki Kato, Mitsunori Yasue, Seiichi Miyaishi, Hiroaki Nakazato

Department of Gastroenterological Surgery, Aichi Cancer Center Hospital

The influence of lymph node dissection on the survival rate of patients with Stage IV gastric cancer was evaluated. In 57 patients who underwent curative resection of N₃ lymph node metastasis, the three-year survival rate (3-YSR) was 63.2%. 3-YSR of patients with relative noncurative resection (rela-NCR) (n=85) and absolute noncurative resection (abso-NCR) (n=18) were 28.2% and 5.6% (p<0.001). In N₄, 3-YSR of rela-NCR (n=6) was 33.3% and that of abso-NCR was 9.5% (N.S.). In P₁, 3-YSR of P₁ alone (N≤R) (n=54) was 27.8% and those of P₁ plus N>R rela-NCR (n=24) and P₁ plus N>R also-NCR (n=17) were 12.5% and 0% (p<0.01). In P₂, 3-YSR of P₂ alone (n=22), P₂ plus rela-NCR (n=17) and P₂ plus abso-NCR (n=10) were 9.1%, 5.9% and 0% (p<0.05). All patients with P₃ factor (total n=28) died within three years after surgery, and no significant differences were observed among the three groups. The 3-YSR of patients with H₁ was 17.6% in the case of H₁ alone (n=17), 11.1% in the case of H₁ plus N>R rela-NCR (n=9) and 12.5% in the case of H₁ plus N>R abso-NCR (n=8) (N.S.). The patients with H₂ or H₃ factor (total n=16) died within two years after surgery (N.S.). The 3-YSR of patients with two or more than two factors of Stage IV was 25.0% in the case of N≤R (n=4) and 0% in the cases of two or more than two factors plus N>R rela-NCR (n=5) or N>R abso-NCR (n=10) (N.S.). In patients with S₃ factor, 46 patients were curatively operated and eleven patients were noncuratively operated. Of these eleven patients, seven were S₃ alone, two were S₃ plus N>R rela-NCR and two were S₃ plus N>R abso-NCR. 3-YSR of S₃ curatively resected was 50.0%, but S₃ was excluded from analysis because of the small number of N>R NCR patients. From these results, we considered that the dissection of metastatic lymph nodes was effective in improving the survival rates of N₃, P₁ and P₂ patients, and might also be effective in N₄ and H₍₊₎ patients.

Key words
lymph node dissection of gastric cancer, survival rate of advanced gastric cancer, noncurative resection of gastric cancer, Stage IV of gastric cancer

Reprint requests
Yoshitaka Yamamura Department of Gastroenterological Surgery, Aichi Cancer Center Hospital
1-1 Kanokoden Chikusa-ku, Nagoya, 464 JAPAN

Accepted
April 14, 1993

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