A Study on Carcinoma of the Gastric Stump with Special Reference to Lymph Node Dissection in the Mesojejunum

Takeo Kosaka, Nobuo Ueshige, Junichi Sugaya, Yasuharu Nakano, Takayoshi Akiyama, Fujio Tomita, Hitoshi Saito, Ichiro Kita and Shigeki Takashima

Department of Surgery II, Kanazawa Medical University

Gastric stump carcinoma originating after Billroth-II (B-II) reconstruction sometimes has lymph node metastasis in the mesojejunum (MJ). We studied the significance of lymph node dissection of the jejunal mesentery from 20 stump carcinomas after B-II reconstruction surgically removed at Kanazawa Medical University. The initial diseases were benign in 15 and malignant in 5 patients. The incidence of lymph node metastasis was microscopically 30% in MJ, 25% in no. 10, 15% in nos. 1, 3, 4 and 11, 10% in nos. 2, 9, 15, 16, and, 5% in nos. 7 and 14. Consequently, as for the degree of lymph node metastasis according to Japanese Classification, 6 patients were n0, 4 were n1-2, 5 were positive in MJ (nMJ) and 5 were n4. All of 7 patients with t1-2 are alive, but 13 patients with t3-4 died within 5 years. Five-year survival was 56% in n0 and 60% in nMJ, while n0 5-year survival was seen in n1-2 or n4. In 14 patients with nodal metastasis, none had survived more than 3 years except two with positive MJ nodes and one with para-aortic node metastasis. These results suggest that, for patients with cancer invading the jejunum, it is important to select appropriate surgical procedures according to the tumor stage, including mesojejunal node dissection.

Key words
carcinoma of gastric stump, surgical procedure, lymph node metastasis in jejunal mesentery, lymphadenectomy for gastric cancer, patient survival for gastric cancer

Reprint requests
Takeo Kosaka Department of SurgeryII, Kanazawa Medical University 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa 920-0293 JAPAN

Accepted
December 9, 1998

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