title: Incidence and prognosis of N4 node involvement in gastric cancer.
abstract: We have undertaken a prospective study of the frequency and prognosis associated with N4 node metastases in gastric cancer in 136 patients referred for surgical treatment between 1976 and 1983. N4 node metastases (pre-aortic or hepatic hilar nodes) were present in 20 of 31 patients who had a laparotomy without resection (64 per cent), in 2 of 8 patients who had a 'palliative' resection in the presence of distant metastases (25 per cent) and, in 19 of 85 patients who had a 'curative' resection (22 per cent). The median survival in patients having a 'curative' resection with N4 nodes was 4.5 months which was only marginally longer than in patients having a 'palliative' resection (median survival 3 months). In view of these findings and since immediate imprint cytology can be used to detect nodal metastases at operation, involvement of N4 nodes might be a contra-indication to extensive gastric resection in non-obstructing gastric cancer.
mesh_terms: D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D010166:Palliative Care; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D013997:Time Factors