Rational Lymph Node Dissection for Upper Third Gastric Cancer with Esophageal Invasion

Kuniyoshi Arai, Masatsugu Kitamura, Yoshiaki Iwasaki

Department of Surgery, Tokyo Metropolitan Komagome Hospital

Rational lymph node dissection was studied in terms of the clinicopathological characteristics of 182 cases of upper third gastric cancer with esophageal invasion. Results were as follows: 1) The metastatic rate of mediastinal lymph node (MNL), which was correlated to the depth of invasion,was 9% in subserosal cancer and 39% in serosal invaded cancer. 2) The patients who did not need MLN dissection could not be determined from the length of esophageal invasion alone, whereas the metastasis of MLN was already found at a 1.0 cm length of esophageal invaslon. 3) Para-aortic lymph node (PLN), especially No. (16) a2 latero and No. (16) b1 latero, was indicated to be the same grade as MLN from the similarity in metastatic rates. In conclusion, active dissection of not only MLN but also PLN with a choice of the appropriate mediastinal approach to relieve the operative load would be rational for the improvement of prognosis in advanced cases with esophageal invasion in whom curative resection can be expected.

Key words
gastric cancer with esophageal invasion, mediastinal lymph node metastasis, para-aortic lymph node metastasis

Reprint requests
Kuniyoshi Arai Department of Surgery,Tokyo Metropolitan Komagome Hospital
3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113 JAPAN

Accepted
April 13, 1994

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