Clinical Results of Para-aortic Lymph Node Dissection in Advanced Gastric Cancer

Jo, Ik Haeng; Yang, Dae Hyun; Kim, Jin Pok; Choi, Won Jin; Kim, Il Myung; Youn, Jin; Park, Sang Su; Yoo, Byung Ook; Ahn, Seung Ik; Choi, Shin Eun

Abstract

PURPOSE: In gastric cancer, metastasis to the paraaortic lymph nodes had been regarded as an incurable factor, but many cases of long term survival have been reported with dissection of metastatic paraaortic nodes. And several reports suggested survival benefit with paraaortic lymph node dissection (D4) in advanced gastric cancer. In patients with advanced gastric cancer who underwent paraaortic lymph node dissection we tried to evaluate the factors predisposing metastasis in these nodes and survival data.
MATERIALS AND METHODS
The authors analyzed retrospectively pathological features of 95 patients who underwent paraaortic lymph node dissection for advanced gastric cancer at Kangnam General Hospital Public Corporation from May 1991 to Feb. 1998. And we also analysed survival results of 72 cases among them. We excluded 18 cases of distant metastasis (3 liver metastasis, 15 peritoneal seeding), 2 operative mortalities, 1 other disease mortality, and 2 unknown causes of death in survival analysis.
RESULTS
The frequencies of paraaortic lymph node metastasis were 0.0% (0 of 32 cases) in T2, 19.2% (10 of 52 cases) in T3, 18.2% (2 of 11 cases) in T4. And those of paraaortic lymph node metastasis were 5.8% (3 of 52 cases) in antrum, 14.3% (3 fo 21 cases) in body, 20.0% (3 of 15 cases) in cardia, and 42.9% (3 of 7 cases) in whole area. The five-year survival rates (5 YSR's) in relation to the paraaortic lymph node (No16) status was 0.0% in No16 , and 57.8% in No16 with D4 of advanced gastric cancer. The 5 YSR's were 78.1%, 40.8% and 0% in T2, T3 and T4, respectively and 93.8%, 64.2%, 24.2% and 0.0% in n0, n1, n2 and n3, respectively and 88.9%, 80.5%, 57.9% and 0.0% (47.6%) and 0.0% in stage IB, II, IIIA, IIIB and IV, respectively.
CONCLUSION
The depth of gastric wall invasion and the location of primary tumor were significant predisposing factors to para-aortic lymph node metastasis in multivariate analysis (p<0.05). Survival of No16 metastasis was very poor. And three factors of T stage, n stage, and Borrmann type were also prognostically significant in terms of five year survival in cases of D4 of advanced gastric cancer in multivariate analysis (p<0.05).