Usefulness of Preoperative Angiography for Surgery for Gastric Cancer

Kiyoshi Sawai, Toshio Takahashi, Hiroki Taniguchi, Shinji Okano, Shigeru Takahashi*, Hajime Tokuda*

First Department of Surgery, Kyoto Prefectural University of Medicine
*Department of Surgery, Kyoto Second Red Cross Hospital

Preoperative angiography was performed for 735 patients with gastric cancer. The sensitivity and accuracy of diagnosis of peritoneal dissemination were 75.4% (86/114) and 93.2% (685/735) respectively. For liver metastasis, they were 80.6% (50/62) and 97.6% (717/735) respectively. The depth of gastric cancer invasion was histologically classified according to the following four groups: (1) mucosa (m) or submucosa (sm), (2) proper muscle layer (pm), (3) serosa (s) and (4) other organs (si). The accuracy of diagnosis of the depth of invasion was 80.2% (486/606). The diagnosis of the depth of invasion correlated well with lymph node metastasis (m-sm; n₀-n₂, pm; n₀-n₃, s-si; n₀-n₄). The patients who underwent radical gastrectomy were devided into four groups according to the feeding arteries. These four groups were compared with regard to the extent of lymph nodes metastasis. (1) The patients who had no identified feeding artery metastasis limited to the perigastric nodes. (2) The patients who had cancer fed by the left gastric, short gastric, left subphrenic and left gastroepiploic arteries had metastases limited to the attendant nodes of the celiac axis and its branches. (3) The patients who had cancer fed by the right gastric, pyloric and right gastroepiploic arteries had metastasis to the lymph nodes along the proper hepatic artery, behind the surface of the head of the pancreas or around the superior mesenteric vein. (4) The patients who had cancer fed by arteries of both groups (2) and (3) above, had para aortic lymph node metastasis.

Key words
angiography for gastric cancer, diagnosis of peritoneal dissemination, feeding artery of gastric cancer

Reprint requests
Kiyoshi Sawai First Department of Surgery, Kyoto Prefectural University of Medicine
Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602 JAPAN

Accepted
November 20, 1991

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