Aim. To study lymphatic metastasis of proximal gastric cancer to determine the extent of surgical intervention both on the stomach wall and lymphatic pathways. Methods. The data on lymphatic metastasis were analyzed in 185 patients with proximal gastric cancer not extending to the esophagus who underwent gastrosplenectomy with extended lymphodissection D2 in 2 surgical departments of the Republican clinical oncology center (Kazan) in 1982-2014. All patients were morphologically verified prior to surgery. 105 out of 185 patients (56.7%) had metastases to lymph nodes. Results. In proximal gastric cancer (within IV and V angiological segments) lymph node involvement in cancer metastases occurs in all sub-segments of the lymphatic system of the stomach. There is a fairly clear pattern: involvement of lymph nodes in metastases mainly occurs in groups №3a, 3b, and 4d, along the common hepatic artery and its branches, around the celiac trunk, along the splenic artery and in splenic hilum. In case of cancer localization in segment IV metastases were observed in 46.7%, in segment V - in 66.7% and in case of involvement of both segments IV and V - in 53.3% of patients. In gastric cancer located within segments IV and V, starting with the involvement of muscular tunic, lymph nodes of perigastric groups (№3b - in 37.1%, 4d - in 11.4%) are often affected as well as parietal lymph nodes of groups 7-12. Conclusion. In cancer located within gastric segments IV and V gastrosplenectomy with extended lymphodissection D2 should be performed to remove lymph node groups along the splenic artery and in splenic hilum.
The aim of the study was to improve surgical outcomes in patients with proximal gastric cancer without invading the esophagus.Material and methods. Data regarding lymph node metastasis, short-term postoperative complications/lethality, and long-term outcomes were analyzed in 162 patients with proximal gastric cancer without invasion of the esophagus. All patients underwent gastrosplenectomy with expanded d2 lymph node dissection. The age of the patients ranged from 25 to 91 years, and the median age was 60 years. There were 105 (64.8 %) patients aged over 60 years and 45 (27.8 %) over 70 years.Results. Postoperative complications occurred in 14 patients (8.6 %), 8 of them (4.9 %) died. The 1-, 3- and 5 year survival rates were 85.4 %, 61.8 %, and 38.9 %, respectively.Discussion. In patients with gastric cancer without esophageal invasion, perigastric lymph nodes (№ 3b, 4d) located in segments iv and v are often affected by metastases; therefore, we consider it inexpedient to perform proximal resections in these cases.Conclusion. In patients with proximal gastric cancer without esophageal invasion, it is not advisable to perform proximal subtotal gastric resections due to the high frequency of 3b and 4d lymph node metastases. Postoperative complication and mortality rates were 8.6 % and 4.9 %, respectively in patients who underwent gastrosplenectomy with d2 lymph node dissection.
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