Indication for the Omission of No. 1 and No. 4sb Lymph Node Dissection in the Operation to Early Gastric Cancer of the Lower Part of Stomach

Hidetoshi Suzuki, Toshinobu Iinuma, Dai Seitoh, Yasunori Mikami, Mitsuhiro Mikami, Yuzuru Sugiyama, Masaaki Endo, Mutsuo Sasaki, Mitsuru Konn

Second Department of Surgery, Hirosaki University School of Medicine

To investigate the advisability of treating early cancer of the lower stomach by contracted operation without No.1 and No. 4sb lymph node dissection, we reviewed 323 cases of resected cancer of the lower stomach and 354 cases of early cancer encountered in the past 21 years. (1) Out of 323 cases of resected cancer of the lower stomach, 151 cases of early cancer and 48 cases of pm cancer were negative for No. 1 and No. 4sb metastases, and 15.3% and 3.2%, respectively, of ss and se cancer cases were positive for these metastases. (2) From the study of two timematched groups, one with 354 early cancer cases and the other with 14 cases of early lower stomach cancer with positive lymph node metastases, it was concluded that the contracted operation without No. 1 dissection was indicated in 1) elevated or depressed (differentiated) m cancer sized 3 cm or less on the anterior wall and lesser curvature, 2) the aforesaid lesion plus combined or depressed (undifferentiated) m cancer sized 2 cm or less on the posterior wall, and 3) the aforesaid lesions plus sm cancer sized 2 cm or less on the greater curvature. (3) In those cases indicated for surgery without No. 1 dissection, the removal of No. 4sb can also be mitted.

Key words
early gastric cancer, lower part of the stomach, regional lymph node dissection, contracted operation

Reprint requests
Hidetoshi Suzuki Second Department of Surgery, Hirosaki University School of Medicine
5 Zaihucho, Hirosaki 036 JAPAN

Accepted
December 8, 1993

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