Relevance of lymph node metastasis along the superior mesenteric vein in gastric cancer.

BACKGROUND: The purpose of this study was to evaluate the prognostic value of lymph node metastasis along the superior mesenteric vein (station 14v) to determine the need for 14v dissection in gastric cancer surgery. METHODS: A total of 1104 patients with gastric cancer who underwent gastrectomy including 14v dissection were enrolled. Patients were categorized into two groups: those with and those without 14v lymph node involvement by metastasis. RESULTS: Of the total study population, 73 patients (6·6 per cent) had 14v-positive gastric cancer. These patients were more likely to have advanced tumour (T), node (N) and distant metastatic (M) status, and histologically undifferentiated gastric cancers. The 3- and 5-year survival rates of patients with 14v-positive disease were 24 and 9 per cent respectively. Survival in this group was similar to that of patients who had gastric cancer with distant metastasis (M1). Multivariable analysis demonstrated that 14v status was a significant prognostic factor for gastric cancer (hazard ratio 2·13; P < 0·001). After histologically complete (R0) resection, the overall survival of 14v-positive patients with any stage of cancer was significantly worse than that for 14v-negative patients with stage IV cancer (P = 0·006). CONCLUSION: 14v status is an independent prognostic factor for gastric cancer, with 14v-positive gastric cancer having a poor prognosis, similar to that of M1 disease. The exclusion of 14v in regional lymph node dissection should be considered.

Radial keratotomy for the purpose of reducing glasses power in high myopia.

Anterior radial keratotomy for high myopia (over-6.25 diopter) to reduce refractive error was not able to dispense with glasses or contact lenses due to the high myopia itself. However patients could see objects well and were free of dizziness while wearing glasses of relatively reduced power. We performed anterior radial keratotomies on 83 high myopic and/or astigmatic eyes of 47 patients at Kangnam St. Mary's Hospital between May 1990 and Mar. 1991. Eight radial incisions with a diamond blade were performed and the Ruiz technique was added for astigmatism of over 2.0 diopters. The depth of incision was 90 to 95% of corneal thickness and the optical zone was 3mm in diameter. Patients were followed up on postoperative 7 days. 1 month, 3 months, 6 months, 1 year and thereafter. Uncorrected visual acuity of 20/40 or better after radial keratotomy could be obtained in 19.6% of high myopic eyes. A mean reduction of the spherical equivalent cycloplegic refraction of 5.13 diopters and a keratometric reading of 3.89 diopters after radial keratotomy were observed. About 90% of patients were satisfied with their visual outcome with reduced refractive power glasses. We recommend radial keratotomy for high myopic patients to reduce the refractive power and to help them enjoy a more comfortable life.