Para-aortic Lymph Node Dissection in Gastric Cancer

ABSTRACT

The para-aortic lymph nodes are the most distal resectable intra-abdominal nodes, to which most lymphatic channels from the stomach converge. Metastasis of gastric cancer to these nodes is regarded as a distant metastasis, and the patient's prognosis is known to be dismal. The purposes of this study are to identify the frequency of metastasis in the para-aortic lymph nodes and to evaluate the therapeutic effect of dissection of these nodes in gastric cancer. Macroscopically identified para-aortic lymph nodes from the left renal vein to the aortic bifurcation were dissected during operation in 173 patients, from among all the patients who underwent surgery for gastric cancer at Kyungpook National University Hospital from 1990 to 1994. Metastases in the para-aortic lymph nodes were found in 26 cases (15%). The frequency of para-aortic lymph node metastasis increased significantly with increasing tumor size and Borrmann type. Neither the tumor location, the depth of invasion, nor the histologic type affected the frequency of metastasis. There were two operative mortalities (1.2%). Twenty-six patients (15%) remained hospitalized for more than 3 weeks postoperatively. There seemed to be a higher incidence of postoperative morbidity in patients with positive para-aortic lymph nodes than in patients with negative nodes, but this difference was not statistically significant. The five-year survival rate of patients with para-aortic lymph node metastasis was 14.4%. Among the patients with para-aortic lymph node metastasis, skip metastasis was found in 11 cases (42%). There seemed to be some survival advantage in patients with skip metastasis, as compared to the positive n3 cases. However, this was not a statistically significant difference. Dissection of the para-aortic lymph nodes did not cause any significant disadvantage in postoperative mortality and morbidity. However, it could not prevent peritoneal seeding or hematogenous metastasis. Based on these data, dissection of the para-aortic lymph nodes seems to have little therapeutic effect, but provides information for accurate staging.