Rational Lymphadenectomy for Gastric Cancer -Is it Necessary a Limited or Extended Dissection?-

Takashi Aikou, Tetsushi Saihara, Shuuichi Hokita, Jyunya Ishigami, Shouji Natsugoe, Sonshin Takao

First Department of Surgery, Kagoshima University School of Medicine

Lymph node metastasis of gastric cancer is one of the most important factors influencing prognosis after surgery. It has been reported that extensive lymphadenectomy enhances the rate of curative surgery and that the outcome is good in patients with gastric cancer. However, recently in Japan more than 40% of gastric cancers, such as mucosal or submucosal carcinoma, have been detected at an early stage. The incidence of lymph node metastasis in early gastric cancer varies with the depth of penetration into the wall of the stomach. Since our data show a significantly lower rate (2.5%) of metastasis to lymph nodes of mucosal tumors or tumors smaller than 2 cm, local resection or preservation of lymph nodes is recommended. With this treatment, it is important to know to what extent we can make an accurate preoperative diagnosis of depth of cancer invasion or lesion size. In this study, we examined the biologic characteristics, of advanced gastric cancer metastasizing to the lymph nodes which have been examined by immunohistochemical study. It was suggested that immunohistochemical expression of Desmoglein antigen in tumor tissue will be useful in predicting lymph node metastases. As for extended dissection, in Japan several institutions have employed this procedure including dissection of the para-aortic nodes. In the present study, we collected data of 53 patients nationwide with para-aortic nodal involvement who survived more than five years after extended lymph node dissection. However, both advantages and disadvantages of extended dissection have been reported. It may be still to early to come to a conclusion. Finally, we propose "Location and depth-oriented therapy" for gastric cancer.

Key words
lymphadenectomy for gastric cancer, early gastric cancer, dissection of para-aortic lymph node

Reprint requests
Takashi Aikou First Department of Surgery, Kagoshima University School of Medicine
8-35-1 Sakuragaoka, Kagoshima, 890 JAPAN

Accepted
December 8, 1993

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