[Lymph node metastasis and the extent of lymph node dissection for gastric cancer: report of 326 cases].
OBJECTIVE
To investigate the pattern of lymph node metastasis and the extent of lymph node dissection for gastric cancer.


METHODS
326 patients with gastric cancer admitted from 1990 to 1999 were analyzed retrospectively after D(2), D(3) or D(3) plus para-aortic lymphadenectomy (D(3) + PAL).


RESULTS
The total incidence of lymph node metastasis was 69.9%; node involvement was 15.4% and 77.4% respectively for early gastric cancer and advanced gastric cancer. Depth of invasion, tumor size and histology affected lymph node metastasis significantly (P < 0.05). For T(1) patients, node involvement was mainly confined to N(1) and one patient had N(2) metastasis; 8.1% of T(2) patients and 28.7% of T(3), T(4) patients had N(3), M(1) lymph node metastasis. Among 107 patients who received D(3) + PAL, 16a2b1 lymph node metastasis was found in 15.0%. The patients who had 16a2b1 node involvement were all suffered from advanced gastric cancer and N(1)-N(2) node metastasis. In the patients with serosal invasion-positive tumors or tumors size over 5 cm, the incidence of 16a2b1 metastasis was high, and that of entire stomach cancer was up to 38.5%. The 3-year and 5-year survival rates for D(3) + PAL group were 60.7% and 50.0% respectively. After D(3) + PAL, the 1-and 2-year survival rate, of patients with 16a2b1 metastasis were 60.0%, 50.0% respectively.


CONCLUSIONS
D(2) lymphadenectomy should be taken for patients with early gastric cancer and D(3) lymphadenectomy for those with relatively early' advanced gastric cancer. For advanced gastric cancer with suspect or confirmed N(1)-N(2) node metastasis, tumor size over 5 cm and/or serosa invasion, D(3) plus para-aortic lymphadenectomy appears to be a necessary surgical procedure.
Wan
Y
Y
Department of General Surgery, First Hospital, Beijing Medical University, Beijing 100034, China.
Pan
Y
Y
Liu
Y
Y
Wang
Z
Z
Ye
J
J
Huang
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate