title: Lymph node metastasis and lymphadenectomy for carcinoma in the gastric cardia: clinical experience.
abstract: METHODS
  To suggest improved guidelines for treating lymphatic spread and to understand the results of extended lymphadenectomy. A total of 141 cases of cardia carcinoma admitted to our hospital during 1980 to 1993 were analyzed.
  
  
  RESULTS
  123 of 141 cases underwent resection. The incidence of mediastinal lymph node involvement rose from 8.7% in cases with 1-2 cm invasion to 52.9% in cases with more than 4 cm invasion into the esophagus. The incidence of abdominal lymph node involvement also rose with increasing esophageal invasion. Paraaortic lymph node metastasis was frequently observed in cases of more than 1 cm esophageal invasion. D4 lymphadenectomy (extended lymphadenectomy) revealed better results for the cases with lymph node involvement (P<0.05). There was no difference in the incidence of postoperative complication or in operative death, between the abdominal approach and the thoracoabdominal approach, or between the D4 lymphadenectomy and D2 lymphadenectomy.
  
  
  CONCLUSIONS
  Sufficient mediastinal and abdominal lymphadenectomy under a clear wide surgical field achieved through the thoracoabdominal approach appeared to bring better results.
authors.affiliation: Department of Surgery, Kurume University School of Medicine, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Kodama
authors.forename: K
authors.initials: K
authors.lastname: Kofuji
authors.forename: S
authors.initials: S
authors.lastname: Yano
authors.forename: K
authors.initials: K
authors.lastname: Shinozaki
authors.forename: N
authors.initials: N
authors.lastname: Murakami
authors.forename: H
authors.initials: H
authors.lastname: Hori
authors.forename: J
authors.initials: J
authors.lastname: Takeda
authors.forename: K
authors.initials: K
authors.lastname: Shirouzu
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology*; D002299:Cardia; D004947:Esophagus / Q000473:pathology; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009362:Neoplasm Metastasis; D011183:Postoperative Complications; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis