Stomach cancer is the most common malignancy in Korea. The unique method to cure stomach cancer is to make an early diagnosis of it. but the majority of cases are diagnosed in the advanced stage.
Extended radical dissection of stomach cancer offers a more accurate stage, and complete removal of the metastatic lymph nodes raises the rate of curability.
It has been revealed for long time that cases with paraaortic lymph node metastasis are impossible to cure. But with several reports of long term survival of cases with paraaortic lymph node metastasis, recently the procedure of paraaortic
dissection
prevails in Japan.
To evaluate the procedure of paraaortic lymph node dissection in advanced stomach cancer, the authors analyzed prospectively 48 cases of paraaortic lymph node dissection except individual nodal picking in the department of surgery, Pusan National
University Hospital.
@ES The results were summarized as follows:
@EN 1) The ratio of male to female was 2 : 1, and in the age incidence, more than 40-years old were 41 cases(85.4%) and under 40-years old were 7 cases(14.6%).
2) The incidence of paraaortic lymph node metastasis in relation to the location of primary tumor was 33.3%(4 of 12 cases) in upper third tumor, 25.0%(4 of 16 cases) in diffuse type of stomach cancer, 16.7%(2 of 12 cases) in lower third tumor,
and
12.5%(1 of 8 cases) in middle third tumor.
3) The incidence of paraaortic lymph node metastasis in relation to the histologic type of primary tumor was 42.9%(3 of 7 cases) in papillary adenocarcinoma, 25.0%(3 of 12 cases) in poorly differentiated adenocarcinoma, 22.2%(2 of 9 cases) in
moderately differentiated adenocarcinoma, 18.2%(2 of 11 cases) in signet-ring cell carcinoma, 12.5%(1 of 8 cases) in well differentiated adenocarcinoma.
4) In the skip metastasis among lymph nodes in group 1, 2, 3 and paraaortic lymph nodes according t Japanese general rule for the gastric cancer study in surgery and pathology, skip metastasis was not revealed in 68.3% of cases and the rate of
metastasis skipping over lymph nodes in group 3 to paraaortic lymph node was 31.7%.
5) In the incidence of paraaortic lymph node metastasis in relation to the number of positive lymph nodes in group 1,2 and 3, the incidence was 16.7%(1 of 6) when the number of positive nodes was less than 10, 26.7%(4 of 15) when it was more
than
10
and under 15, 35.4%(4 of 11) when it was more than 15 and under 20, and 66.7%(2 of 3) when it was more than 20.
6) In postoperative complications, left pleural effusion, acute pancreatitis, and intraabdominal abscess were in 2 cases(4.2) respectively, and adhesive ileus requiring operation was in 1 case(2.1%)
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