Indication for Dissection of Splenic Hilar Lymphnodes for Upper Gastric Cancer Located in Lesser Curvature

Takashi Nomura, Shigekazu Ohyama, Keiichiro Ohta, Toshiki Matsubara, Takashi Takahashi, Toshifusa Nakajima and Tetsuichiro Muto

Department of Surgery, Cancer Institute Hospital

Splenic hilar lymphnode dissection is often performed in patients with advanced gastric cancer in the upper third of the stomach. In respect to the lymphatic system, there is no route between the lesser curvature area and the splenic hilus, so cancer located in the lesser curvature may not metastasize to splenic hilus lymph nodes. We discuss indications for splenic hilar lymph node dissection for cancer in the lesser curvature of the upper third of the stomach. In 515 cases of curatively resected upper-third gastric cancer with splenic hilar lymph node dissection, there were 68 (13.2%) with positive nodes. Of these, 57 cases (83.8%) had tumors that were located either on the left side or the margin between the left and right areas. But there were 11 cases (16.2%) with lesions located in the lesser curvature. Of these 11 all had positive nodes in the lesser curvature, and 10 had lymph node swelling and adhesion. So we speculate that metastatic lymph nodes may block the lymphatic route and change the flow direction of lymphatic fluid, thus, making metastasis to splenic hilar lymphnodes possible. On the other hand, in considering tumors smaller than 40 mm, there was only one case with splenic hilar lymph node metastasis located in the lesser curvature. And this one have positive nodes in lesser curvature. In conclusion, splenic hilar lymph node dissection for cancer located in the lesser curvature of the upper third of the stomach is unnecessary in cases without metastasis in the lesser curvature lymph nodes and with tumors smaller than 40 mm.

Key words
gastric cancer in the upper third of the stomach, splenic hilar lymphnodes, pancreatosplenectomy, splenectomy

Reprint requests
Takashi Nomura First Department of Surgery, Yamagata University School of Medicine 2-2-2 Iidanishi, Yamagata, 990-9585 JAPAN

Accepted
June 28, 2000

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