The Evaluation of the Survival and Quality of Life in the Autonomic Nerves and Plexuses Preserving Paraaortic Lymph Node Dissection for Advanced Gastric Cancer

Hiroyuki Yamaoka, Masazumi Takahashi, Chikara Kunisaki, Noriomi Hosaka, Masato Nomura, Jun-ichi Wakasugi, Hiroshi Shimada

Second Department of Surgery, School of Medicine, Yokohama City University

One hundred and fifteen patients have received autonomic nerve- and plexus-preserving paraaortic lymph node dissection for advanced gastric cancer (depth of tumor invasion to more than the muscle layer) during the last 5 years in our department. These patients were classified into four groups: 1) all nerves and plexuses preserved (bilateral major and minor splanchnic nerves, bilateral celiac plexuses and SMA plexus), n=61; 2) right side preserved, n=47; 3) left side preserved, n=4; and 4) all nerves and plexuses resected, n=3. The rate of paraaortic node involvement was more than 20% ln the cases in which the depth of the tumor invasion was to more than the subserosal layer. It was not useful for the patients in whom the number of involved paraaortic nodes was more than 15 or in whom all sites of the paraaortic node area were involved. The 5-year survival rate for the patients with extended lymph node dissection (paraaortic node dissection, D4), whose tumors invaded to the serosal layer or other organs, was significantly better than those receiving conventional node dissection (D2). Paraaortic node dissection preserving the splanchnic nerves, celiac plexus and SMA plexus (all preserved or right side preserved) was useful because the rate of occurrence of post-operative watery diaarhea was less than 4%, and there was no paraaortic node recurrence. However, male sexual function (ejaculation) was poor in the patients receiving paraaortic node dissection.

Key words
advanced gastric cancer, paraaortic lymph node dissection, autonomic nerve and plexus preserving surgery, post-operative watery diarrhea, male sexual function

Reprint requests
Hiroyuki Yamaoka Second Department of Surgery, Yokohama City University
3-36 Urafunecho, Minamiku, Yokohama, 232-0024 JAPAN

Accepted
December 3, 1997

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