Indications for Dissection of Lymph Nodes Located in the Splenic Hilus and Around the Splenic Artery According to Clinical Stage of Gastric Cancer

Hideki Ura, Ryuichi Denno, Koichi Hirata

First Department of Surgery, Sapporo Medical University

The indications for dissection of lymph nodes located in the splenic hilus (No. (10)) and around the splenic artery (No. (11)) was studied according to clinical stage of gastric cancer in 557 patients with primary gastric cancer located in the upper-middle or whole stomach. Dissection of those lymph nodes was not essential in patients with early gastric cancer but is indicated for all patients diagnosed with advanced gastric cancer. Pancreaticosplenectomy (PS) should be chosen for the following cases: tumor size greater than 8 cm in diameter, S_2-3 a smacroicopic serosal invasion, and positive metastasis in lymph node(s) found under operation. On the other hand, pancreas-preserving operation with removal of the splenic artery (PP) might be chosen for the following cases: tumor size smaller than 4 cm, S_0-1 and N(-) diagnosed preoperatively by imaging diagnosis and under operation. Five-year survival rates of the PS and PP groups were as follows: Stage I: 96.3%, 100%; stage II: 64.0%, 79.6%; stage III:39.8%, 35.6%; stage IV: 20.8%,0%. The PP group showed the same survival rates as the PS group in stages I, II and III. Therefore, PP might be indicated for patients in those stages. However, patients in stage III or IV were revealed to have high incidences of metastasis to No. (10) and No. (11) lymph nodes, and so PS should be chosen for those cases.

Key words
gastric cancer, lymph node metastasis of gastric cancer, lymph nodes located in the splenic hilus and around the splenic artery, pancreatico-splenectomy, pancreas-preserving operation

Reprint requests
Hideki Ura First Department of Surgery, Sapporo Medical University
Sough 1, West 16, Chuo-ku, Sapporo, 060 JAPAN

Accepted
December 8, 1993

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