胃癌における大動脈周囲リンパ節転移に関する臨床病理学的検討

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  • Clinico-pathological Studies on Para-aortic Lymph Node Metastasis in Gastric Cancer.

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The significance of para-aortic lymph node dissection in gastric cancer was studied from the viewpoints of histological metastasis and the investigation of lymphatic flow by using activated carbon (CH40). Investigation of lymphatic flow in 66 cases of gastric cancer revealed a high staining rate in the para-aortic lymph nodesregardless of the carbon injection site in lymph nodes of the first group. However this finding did not completely conform to the actual state of lymph node metastasis according to the cancer location. Para-aortic lymph nodes were dissected in 257 clinical cases and metastases were seen in 59 cases (23.0%). The metastatic rate increased with depth of the cancer. High metastatic rates were obtained in macroscopic type 3, type 4 and histologically undifferentiated type. As the lymphatic invasion advanced the metastatic rate increased. Concerning the location of the cancer and the site of metastasis in the para-aortic lymph nodes, the metastatic rate was high on the left side of the aorta in cases of C area cancer, while metastasis was observed on both sides of the aorta in cases of M and A area cancer. Therefore, careful dissection of the para-aortic lymph nodes should be performed in M and A area cancer. Thirty cases in the n3 (-) group among 59 cases with n4 (+) showed a significantly better outcome than the 29 cases in the n3 (+) group (p<0.01). This finding shows the significance of dissection of the para-aortic lymph nodes. According to our results, this lymph node dissection should be performed in cases exceeding subserosal invasion (S1) and N2 (+).

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