Abstract
Extended radical gastrectomy for advanced gastric cancer consists of wide gastric resection, extended lymphnodal dissection and saccate bursectomy. In patients with cancer involving the proximal one-third region (C) total gastrectomy is necessary, but in the other patients distal subtotal gastrectomy is recommended. Lymphnodal dissection through the 1st, 2nd and 3rd groups (R3 in The General Rules for the Gastric Cancer Study by the Japanese Research Society for Gastric Cancer) is performed with Cooper scissors, leaving only the artery, vein and bile duct. Saccate bursectomy is aimed to prevent cancer cell dissemination from the lesion invading the serosa of the posterior gastric wall. The rate of metastasis to the third lymphnodal group (n3) was 17.1% in all, 31.8% in cases of ps (+) in histological depth of invasion, and 63.6% in stage IV. Therefore, extended lymphnodal dissection (R3) has to be performed for cases of ps (+). The survival rate was increased by extended lymphnodal dissection in stage III and stage IV. No recurrence of peritoneal dissemination was seen after saccate bursectomy in the cases of posterior wall ps (+).
