Y. Kodera et al., Lymph node metastasis in cancer of the middle-third stomach: Criteria for treatment with a pylorus-preserving gastrectomy, SURG TODAY, 31(3), 2001, pp. 196-203
A retrospective study was conducted to establish the criteria for performin
g a pylorus-preserving gastrectomy. This study was performed on 491 patient
s who had cancer of the middle-third stomach and had been curatively treate
d with a distal gastrectomy. The incidence of node metastasis for each lymp
h node station (the group of regional lymph nodes which have been anatomica
lly defined and classified by the Japanese Classification of Gastric Carcin
oma) was evaluated with reference to the depth of invasion, tumor size, and
circumferential location, to show any significant correlations with an inc
rease in tumor diameter or in the depth of tumor invasion. The benefits of
resecting each station was then evaluated based on the incidence of metasta
sis to each station and the rate of long-term survivors among those with me
tastasis to each station. The benefit was substantial for the lymph nodes a
long the lesser curvature, along the right gastroepiploic artery, and at th
e base of the left gastric artery, while the advantages were almost negligi
ble for the suprapyloric nodes and right paracardial nodes. In conclusion,
carcinoma that fulfills either of the following conditions may thus be indi
cated to undergo a pylorus-preserving gastrectomy: (i) restricted to a dept
h of m of sm1, (ii) a depth of sm2 or mp with a diameter of less than 2 cm,
(ii) a depth of sm2 or mp and located in the greater curvature.