BACKGROUND/AIMS: We investigated the frequency of para-aortic lymph no
de involvement and evaluated the effects on survival of dissection of
these lymph nodes in patients with N4 node metastasis. METHODOLOGY: On
e hundred and forty nine gastric cancer patients with N4 node dissecti
on were analyzed. Total gastrectomy with splenectomy or pancreatosplen
ectomy was performed in 99, distal gastrectomy 48, pancreaticoduodenec
tomy 3, and proximal gastrectomy with splenectomy 2. RESULTS: N4 nodal
involvement was found in about 30-40% of operable patients with Borrm
ann's type 3 or 4 tumor, with tumor > 8cm in size, with tumor througho
ut the entire or in the upper third of the stomach, with tumor invasio
n to the serosa or adjacent structures, with N2 or N3 regional lymph n
ode metastasis, and with undifferentiated histological type. The survi
val was quite poor. However, in patients without N3 nodal involvement
or intraperito-neal free cancer cells, the survival after resection of
tumor with N4 nodal involvement was relatively favorable. CONCLUSIONS
: The resection of these involved lymph nodes can be expected to be be
neficial in patients without extensive serosal invasion and without ex
tensive lymph nodal involvement such as N3 nodes. Patients with tumor
in the upper third of the stomach are appropriate candidates for N4 no
de dissection.