A Case Report of Advanced Gastric Cancer Patient Who had 26 Para-Aortic Metastatic Nodes and Survived More than 5 Years

Katsuki Muneoka, Atsushi Nashimoto, Juei Sasaki

Division of Surgery, Niigata Cancer Center Hospital

A 54-year-old woman with advanced gastric cancer underwent total gastrectomy, splenectomy, and resection of the caudal pancreas with para-aortic lymph node dissection. Microscopic examination showed the tumor to be a poorly differentiated adenocarcinoma that invaded to the subserosal layer. There were many lymph node metastases, and the number of positive para-aortic nodes was 26. Postoperative adjuvant chemotherapy consisted of sequential 5 FU and MTX therapy. As of 6 years and 2 months, there have been no signs of recurrece and she is alive and healthy. Several institutions in Japan have employed extended dissection of para-aortic lymph nodes. In this case, the number of metastatic para-aortic lymph nodes was 26, the largest number in the world. There have been no reports of a 5-year survivor with more than 20 positive para-aortic nodes. Para-aortic lymph node dissection is indicated for patients with H0, P0, T3 and/or N2 except for absolutely non-curative cases. The significance of para-aoritc lymph node dissection should be confirmed by a large-scale prospective randomized control study.

Key words
gastric cancer, para-aortic lymph node dissection, 5year survivor with No. 16 positive node

Reprint requests
Atsushi Nashimoto Division of Surgery, Niigata Cancer Center Hospital
2-15-3, Kawagishicho, Niigata, 950 JAPAN

Accepted
May 17, 1995

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