Surgical Treatment of of Gastric Cancer Patients from the Viewpoint of the State of Lymph Node Metastasis and Prognosis

Masatsugu Kitamura, Kuniyoshi Arai, Yoshiaki Iwasaki

Tokyo Metropolitan Komagome Hospital

We evaluated the surgical treatment of gastric cancer patients from the viwpoint of dissected lymph nodes and prognosis. Various surgical treatments, including an endoscopic procedure, were thought to be possible in mucosal cancer depending on lymph node metastasis, macroscopic type and tumor size, namely, endoscopic mucosal resection (9%), surgically local resection (35%) and gastrectomy with R₁+No. 7 lymph node dissection (56%). However, R₂ lymph node dissection is necessary for almost all submucosal cancer. High efficacy of dissection of second group lymph nodes was seen in tumors of the lower third of the stomach. However, this type of dissection was not effective for tumors in M and C locations. No. 12 lymph node dissection among third group lymph nodes showed the best prognosis, with a 5-year survival rate of 35%. Location M cancer with No. 12 lymph node metastasis showed a 5-year survival rate of 27% by removing the lymph nodes. Patients with No. 16 lymph node metastasis showed a 5-year survival rate of 19% in patients without liver metastasis or peritoneal dissemination. No. 16 metastasis patients with n3(-) showed a significantly better outcome than n3(+) patients. It is considered that n3(-) patients among No. 16 positive patients have the benefit of prophylactic lymph node dissection in this area.

Key words
surgical treatment, efficacy of lymph node dissection, paraaortic lymph node dissection

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

Accepted
December 8, 1993

To read the PDF file you will need Abobe Reader installed on your computer.