title: Metastases to the para-aortic lymph nodes in adenocarcinoma of the cardia.
abstract: OBJECTIVE
  To find out the extent of involvement of the para-aortic nodes in patients with adenocarcinoma of the gastric cardia.
  
  
  METHODS
  Open prospective study.
  
  
  METHODS
  Teaching hospital, Italy.
  
  
  METHODS
  23 patients with advanced adenocarcinoma of the cardia (type II, n = 10, and type III, n = 13) who were treated by total gastrectomy with resection of the distal oesophagus and extended lymphadenectomy (D4) between January 1997 and June 1999. These were compared with 21 patients with advanced carcinoma of the proximal third of the stomach who had total gastrectomy with D4 lymphadenectomy during the same period. Lymph nodes were retrieved immediately postoperatively and assigned to the appropriate station according to the classification of the Japanese Research Society for Gastric Cancer.
  
  
  METHODS
  Number of para-aortic and other nodes involved.
  
  
  RESULTS
  22 of the 23 patients had lymph node metastases, and in 5 the para-aortic nodes were involved (N4). N3 lymph nodes were involved in only 1 patient, despite involvement of para-aortic nodes. Among the 5 patients with N4 metastases, 1 had only N1 metastases in addition, with no involvement of N2 or N3 nodes. Patients with involved N4 nodes had more nodes involved overall than those who did not (mean (SD) 17 (5) compared with 8 (12)).
  
  
  CONCLUSIONS
  5/23 patients with advanced carcinoma of the cardia had involved para-aortic nodes. This may have some prognostic value, but larger studies of D4 lymphadenectomy specimens is required.
authors.affiliation: 1st Division of General Surgery, University of Verona, Italy. Semchi@Borgotrento.Univr.it
authors.forename: G
authors.initials: G
authors.lastname: de Manzoni
authors.forename: C
authors.initials: C
authors.lastname: Pedrazzani
authors.forename: A
authors.initials: A
authors.lastname: Di Leo
authors.forename: M
authors.initials: M
authors.lastname: Bonfiglio
authors.forename: S
authors.initials: S
authors.lastname: Tasselli
authors.forename: A
authors.initials: A
authors.lastname: Guglielmi
authors.forename: C
authors.initials: C
authors.lastname: Cordiano
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary*; D000368:Aged; D002299:Cardia; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery