Rational Lymph Node Dissection for Early Cancer in the Middle Portion of Stomach -Indication for the Omission of No. 1, 5 and 6 Lymph Node Dissection-

Hidetoshi Suzuki, Takashi Itoh, Jun Suzuki, Yasunori Mikami, Yuzuru Sugiyama, Mitsuhiro Mikami, Katsuro Takahashi, Eishi Totsuka, Kageyoshi Seino, Masaaki Endoh, Mutsuo Sasaki, Mitsuru Konn

Second Department of Surgery, Hirosaki University School of Medicine

The indication of omitting the No. 1, 5 and 6 lymph node dissection for the early gastric cancer of the M region was examined. The subjects consisted of 378 cases of single gastric cancer of the M region (early stage 199 cases, advanced stage 179 cases) and a total 230 cases of m cancer in the same period. In the M region, metastasis in the lymph node was observed in 2.9% (3/105) of m cancer, all of which were undifferentiated IIc type with Ul (+). There were 2 cases (1.9%) of metastasis in the No. 1 lymph node but no metastasis was found in the No. 5 nor 6. In 94 cases of sm cancer, 1 case (1.1%) of metastasis was seen in the No. 1, and 3 cases (3.2%) of metastasis in the No.5 and 6. In 125 cases of m cancer of other area,2 cases of metastasis in the lymph node were seen in the depressed type with Ul (+). In 146 cases of the depressed m cancer, rate for metastasis in the lymph node was 1.2% (1/75) for differentiated type and 5.6% (4/71) for undifferentiated type. In relation to Ul, that rate was 0.0% (0/68) for Ul (-) and 6.4% (5/78) for Ul (+). No metastasis was observed in the tub₁, Ul (-). tub₂ and undifferentiated type with Ul (-). Furthermore, the relation between the metastasis and diameter of the carcinoma was examined and the following M localized m cancer was considered as a candidate for omission of No. 5 and 6 lymph node dissection; elevated type of 5.0 cm diameter or less; as for depressed type (IIc) of tub₁ of 4.5 cm or less, Ul (-). tub₂ of 4.0 cm or less and undifferentiated Ul (-) of less than 1.0 cm diameter. From additional examination, it was determined that there was a possibility to omit the dissection of No. 1 and 5 lymph node in the m gastric cancer that is located in the greater curvature.

Key words
early gastric cancer, middle portion of stomach, rational lymph node dissection, No. 1,5 and 6 lymph node

Reprint requests
Hidetoshi Suzuki Second Department of Surgery, Hirosaki University School of Medicine
5 Zaifuchou, Hirosaki, 036 JAPAN

Accepted
February 8, 1995

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