Clinico-pathological Studies on Para-aortic Lymph Node Metastasis and Post-operative Quality of Life in Gastric Cancer Patients

Masatsugu Kitamura, Kuniyoshi Arai, Yoshiaki Iwasaki

Department of Surgery, Tokyo Metropolitan Komagome Hospital

The significance of para-aortic lymph node dissection and quality of life was studied from the viewpoint of clinicopathological findings. Para-aortic lymph nodes were dissected in 333 cases and metastasis was seen in 67 cases (20.1). The metastatic rate increased with the depth of cancer. High metastatic rates were seen in macroscopic type 3 and type 4 and in the histologically undifferentiated type. As lymphatic invasion advanced, the metastatic rate increased. Concerning the location of the cancer and the site of metastasis in the para-aortic lymph node, the metastatic rate was high on the left side of the aorta in cases of C area cancer, while metastasis was observed on both sides of the aorta in cases of M and A area cancer, the 33 cases in the n3 (-) group among 61 cases with n4 (+) showed a significantly better outcome than the 28 cases in the n3 (+) group (p<0.05). According to our results, this lymph node dissection should be performed in cases exceeding subserosal invasion and N2 (+). Concerning the relationship between para-aortic lymph node dissection and QOL, blood loss in the No.16 lymph node dissection group was greater and the length of surgery was longer than in the non-dissected group. Serum protein in the No.16 dissected group was signficantly decreased on the 7th postoperative day compared with the non-dissected group, and body weight in the dissected group decreased further than in the non-dissected group. Further studies should be done to determine the significance of para-aortic lymph node dissection and the effect of this procedure on QOL.

Key words
para-aortic lymph node metastasis, para-aortic lymph node dissection, gastric cancer, prognosis, quality of life

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

Accepted
April 13, 1994

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