J.Jpn. Surg. Soc.. 54(1): 38-42, 1953

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Original article

ON THE SCOPE OF APPLICATION OF TOTAL GASTRECTOMY CONSIDERED IN CONNECTION WITH THE LYMPHATIC SYSTEM OF THE STOMACH

My experimental investigation of the formation of a collateral passage of the lymphatic of the stomach in animals and observation on the lymphatic system of the stomach in patients of stomach cancer, have disclosed that cancer cells may possibly exist in the fundus in cases where the lymph passage is obstracted in the right paracardiac lymph node in the anterior wall or in the distal right paracardiac lymph node in the posterior wall. I have temporally dicided from a theoretical point of view on a critical line of indication between partial and total gastrectomy.
Taking into consideration the results of our clinical experience and patho-histological examination of specimens, the following conclusions have been reached as to the critical line:
1) When the presumable oral side of the tumor is within 6 cm from the caudal side of the cardia, total gastrectomy should be enforced, no matter which Borrmann's type the growth of the tumor takes or whether the tumor is found on the anterior or the posterior.
2) In the majority of cases where the lesion is located on the pylorus side of the critical line, it is possible to prevent cancer cells from being left in the remnant of the stomach after partial gastrectomy and so removal of the lymph nodes in the cranial parts of the pancreas or near the hepatic hilus, instead of total gastrectomy, should be performed.
3) When the lesion is located on the posterior wall between the critical line and a portion 6 cm apart from the caudal side of the cardia, the preference for total or partial gastrectomy remains to be determined by future research.
(author's abstract)

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