A Clinicopathological Study of Gastric Cancer with Duodenal Invasion

Kiyotaka Yamamoto

Department of Gastroenterological Surgery, Tokyo Women's Medical College (Head: Porf. Fujio Hanyu, Director: Prof. Hiroyoshi Suzuki)

In order to establish a policy regarding extended radical dissection of lymph nodes located beyond Group 3 in patients with advanced cancer of the lower stomach with duodenal invasion, I started with the hypothesis that the extent of metastasis to these groups of lymph nodes would be proportional to the tumor volume invading into the duodenum. Metastasis to the lymph nodes of Groups 3 and 4 was studied with respect to the following four factors, which could be evaluated by preoperative imaging diagnosis: 1) the length of tumor invasion into the duodenum, 2) the depth of invasion on the pyloric ring, 3) the circumferential extent of pyloric ring invasion, and 4) the pattern of invasion into the duodenum. The following results were obtained. (1) The rate of metastasis to the lymph nodes of Groups 3 and 4 was high when the length of duodenal invasion was over 10 mm, the depth of invasion on the pyloric ring was pm or greater, the circumferential extent of pyloric ring invasion was over 50%, and the pattern of invasion into the duodenum was the deep or full type. (2) When a score was assigned to each of these four factors, the following formula was able to predict metastasis to the lymph nodes of Groups 3 and 4: Z (X)=0.23X1+0.27X2+1.19X3+0.61X4-623, where X1 is the length of duodenal invasion, X2 is the depth of invasion on the pyloric ring, X3 is the circumferential extent of pyloric ring invasion, and X4 is the pattern of invasion into the duodenum. In the future, it should be possible to determine each factor by preoperative imaging studies, obtain a value for Z (X) by scoring the factors, and thus estimate the risk of metastasis to lymph nodes beyond Group 3. In conclusion, it was considered possible to preoperatively determine the need for extended radical dissection of the lymph nodes of Group 3 and 4 by concomitant use of imaging diagnosis.

Key words
gastric cancer with duodenal invasion, extended radical dissection of the lymph nodes, factors relating to meastasis to the lymph nodes beyond Group 3

Reprint requests
Kiyotaka Yamamoto Department of Gastroenterological Surgery, Tokyo Women's Medical College
8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162 JAPAN

Accepted
May 11, 1993

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