Optimal Operation for Gastric Cancer Based upon No. 10 and 11 Lymph Node Status in Patients Undergoing Total Gastrectomy with Distal Pancreatectomy and Splenectomy

Hideaki Yamanami, Tsuneaki Fujiya and Kiyoaki Ouchi

Department of Surgery, Miyagi Cancer Center Hospital

Various clinicopathological factors influencing lymph node metastasis at the splenic hilum (No. 10) and along the splenic artery (No. 11) were studied retrospectively in 130 advanced gastric cancer patients who underwent total gastrectomy with distal pancreatectomy and splenectomy. Significant factors affecting incidences of No. 10 lymph node metastasis were tumor location, macroscopic appearance, histologic appearance, sex and peritoneal metastasis. Logistic regression analysis revealed that location, macroscopic appearance of tumors, sex and peritoneal metastasis were valuable factors affecting No. 10 lymph node metastatis. Except for peritoneal metastasis, no factors significantly influenced No. 11 lymph node metastasis. In conclusion, total gastrectomy with distal pancreatectomy and splenectomy is indicated for patients who develop tumors with macroscopically positive infiltration to the serosa that: (1) locate in the greater curvature or anterior wall of the stomach, (2) show macroscopically type 1 or 4, or (3) female. On the other hand, patients who have other kinds of tumors can be treated with pancreas-preserving total gastrectomy.

Key words
gastric carcinoma, lymphnode metastasis at the splenic hilum and along the splenic artery for gastric carcinoma, total gastrectomy with distal pancreatectomy, logistic regression analysis for gastric carcinoma

Reprint requests
Hideaki Yamanami Department of Surgery, Miyagi Cancer Center Hospital 47-1 Nodayama, Shiode-Medeshima, Natori, 981-1293 JAPAN

Accepted
April 28, 1999

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