Study on Mode of Cancer Cell Infiltration to Connective Tissue around Lymph Nodes in Gastric Cancer Patients with Peritoneal Recurrence

Kikuo Koufuji, Jinryo Takeda, Issei Kodama, Keishirou Aoyagi, Yano Shojirou, Junji Ohta, Kazuki Mizutani, Hiroki Takamiya, Kazuo Shirouzu

First Department of Surgery, Kurume University School of Medicine

Forty-eight gastric cancer patients with peritoneal recurrence after the curative operations were analyzed retrospectively. The distribution of n-staging in the general rules for gastric cancer established by the Japanese Research Society was 22 cases with n₁ and 12 cases with n₂. Among these, 23 gastric cancers had infiltrated the connective tissue around lymph nodes. The ratios of male and tumors located in A region were significantly increased in cases with cancer cells infiltrating around lymph nodes as compared to cases without such infiltrative cancer cells (p<0.05). The incidence of infiltration to connective tissue around lymph nodes was 31.8% in n₀, 57.1% in n₁, 66.7% in n₂. The microscopic mode of cancer cell infiltration was classified into extra-nodal invasion in 12 cases and very small disseminated metastasis in 11 cases. The extranodal invasion mode was frequently recognized in cases with lymph node involvement. These lesions were often found at perigastric lymph nodes in the greater or lesser omentum and were presumed to carry a diagnosis of P₁ according to the general rules for gastric cancer established by the Japanese Research Society. It is difficult to diagnose these P₁ lesions macroscopically and intraoperatively. Therefore, intraoperative pathological diagnosis of cancer cells infiltrating around lymph nodes is recommended for propylactic treatment against peritoneal recurrence.

Key words
gastric cancer, peritoneal dissemination, lymph node metastasis, extranodal invasion, peritoneal recurrence

Reprint requests
Kikuo Koufuji First Department of Surgery, Kurume University School of Medicine
67 Asahimachi, Kurumeshi, 830 JAPAN

Accepted
September 11, 1996

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