[Stratified removal of the lymph nodes during resection of advanced carcinoma in the upper part of the stomach].
In 1625 cases of advanced gastric carcinoma in the upper part of the stomach, the R2-removal of the lymph nodes was performed combined with splenectomy and distal pancreatectomy. Five-year survival rate was, however, not satisfactory: 48.4%. Results of our study with double isotope method showed that all of the lymphatic flow finally went to the para-aortic lymph nodes (n16). The results may indicate the importance of distinguishing three categories from the viewpoint of lymphatic flow. The new way of operation with lymph nodes removal as far as the third stratum was applied to 109 cases with advanced gastric carcinoma. Here the intervention to the third stratum means the removal of n16 lymph nodes. The five-year survival rate improved to 64.8%. The value was significantly higher than that of the cases without removal of n16 (p less than 0.01). However, the results confined to cases with positive lymph nodes metastases to n16 were not yet satisfactory. This may lead to the conclusion that the removal of the n16 lymph nodes will not promise the improvement of prognosis if metastases to the n16 lymph nodes were already apparent at operation. Therefore, the validity of removing the lymph nodes as far as the third stratum will be limited for the cases in which metastases are within the first and second strata.
Suzuki
H
H
Institute of Gastroenterology, Tokyo Women's Medical College, Japan.
D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*