Abstract
Gastric stump carcinoma originating after Billroth-II(B-II)reconstruction sometimes has lymph node metastasis in the mesojejunum (MJ). We studied the significance of lymph node dissection of the jejunal mesentery from 20 stump carcinomas after B-II reconstruction surgically removed at Kanazawa Medical University. The initial diseases were benign in 15 andmalignant in 5 patients. The incidence of lymph node metastasis was microscopically 30% in MJ, 25% in no. 10, 15% in nos. 1, 3, 4and11, 10% in nos. 2, 9, 15, 16, and, 5% in nos. 7and 14. Consequently, as for the degree of lymph node metastasis according to Japanese Classification, 6 patients were n0, 4 were n1-2, 5were positive in MJ(nMJ)and 5 were n4. All of 7 patients with t1-2 are alive, but 13 patients with t3-4 died within 5 years. Five-year survival was 56% in n0 and 60% in nMJ, while n0 5-year survival was seen in n1-2or n4. In 14 patients with nodal metastasis, none had survived more than 3 years except two with positive MJ nodes and one with para-aortic node metastasis. These results suggest that, for patients with cancer invading the jejunum, it is important to select appropriate surgical procedures according to the tumor stage, including mesojejunal node dissection
