Abstract
We analysed 454 gastric cancers treated in curative resection at the Department of Surgery, Kansai Medical University between 1980 and December 1990. In proxmal cancer, we found n2 (+) cases in advanced cancer, so we should perform cardiectomy only for gastric cancer. In advanced proxmal cancers, there are many cases (76%) which have the metastasis to the lymph node along the splenic artery. So, pancreato-splenectomy is indicated for the S (+) and N2 (+) cases in proximal cancer. In middle cancer, lymph node metastasis was to under the group 2 nodes even in cancer which invaded into the proper muscle layer, we therefore should be lymphadenectomy of perigastric nodes and those located along left gastric, common hepatic arteries in early gastric cancer. But in advanced cancer we can often see cases of metastasis to the nodes along the splenic artery, so we need R3 lymphadenectmy with combine resection of pancreas tail and spleen for such cases. In distal cancer, lymph node metastasis extended to the lymph node in the hepatoduodenal ligament in advanced cancer, so we should remove all lymph nodes of group 1, 2 and the node in the hepatoduodenal ligament, even early gastric cancer. Concerning to the para-aortic nodes, the metastatic rate was 11.8%, and all the metastasized cancers were invaded beyond the serosal site. Therefore we should perform lymphadenectomy of para-artic nodes in the case of cancer which have serosal invasion, the metastatic cases were S (+) cancer.
