1997 Volume 58 Issue 7 Pages 1509-1512
We report herein an unusual case of advanced gastric cancer in a 60-year-old man who survived over 10 years after a gastrectomy which resulted in non curative operation for wide-ranging involvement of lymph nodes extending to the paraaortic lymph node. The patient underwent a total gastrectomy, distal pancreatectomy, and splenectomy with D3 plus partial D4 lymph node dissection for advanced gastric cancer of Borrmann type 3 in 1983. Post operative histological examination revealed poorly differantiated adenocarcinomas in 45 out of the 52 resected lymph node including paraaortic lymph node. The patient uneventfully recovered and was discharged on the day 35 after the surgery. No postoperative chemotherapy was added. The patient had been followed on an ambulant basis for 2 years after the surgey, but thereafter he discontinued visiting the hospital. Ten years after the surgery, the patient was seen at the clinic because of intermittent abdominal pain. Abdominal X-ray, computed tomography and abdominal echogram revealed choledocholithiasis and a tumor mass along the abdominal aorta. The patient underwent a radical surgery for choledocholithiasis and excisional biopsy for histologic diagnosis of the tumor mass along the abdominal aorta. Postoperative histological examination of the biopsy sample revealed poorly differantiated adenocarcinoma. These findings showed that the remnant cancer cells coexisted with the patient without marked growth and expansion during 10 years after the surgery. We might have to reconsider the significance of dissection of paraaortic lymph node in the operation of gastric cancer.
