J.Jpn. Surg. Soc.. 54(8): 649-657, 1953
Original article
A CRITICISM ON PARTIAL GASTRECTOMY ON THE BASES OF HISTOLOGICAL EXAMINATION OF REMOVED CANCEROUS STOMACHS
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Department of Pathology, Faculty of Medicine, Kyushu University (Director: Prof. T. Imai) Satoru FUKUSHIGE |
In 11 totally extirpated specimens in which all macroscopically observable lymph nodes situated mainly on the lesser curvature had been removed directly after the operation, there were still found microscopically a number of small lymph nodes which had escaped the removal, showing the difficulty of practising a complete removal of all metastasized lymph nodes. In 3 out of these 11 cases there were seen carcinoma cells staying in the lymph vessels of the stomach wall far distant from the advancing margin of the tumor. These cells might easily be left behind in the partial resection of the stomach even if the cleaning off of all lymph nodes be possible.
Of 135 partially resected specimens, about one-third have been resected at (30 cases, 22 per cent) or near (20 cases, 15 per cent) the region already infiltrated with carcinoma cells. Among those cases, 64% of Borrmann-IV-Type cases, 54% of subtotally resected cases, and 53% of cases which should be included among Uchinoura's indication for total extirpation of the stomach, were found resected at the region of carcinomatous infiltration.
In the microscopic examination of the so-called infiltrating form of gastric carcinomas, it was found that the continuous carcinomatous infiltration can spread 7cm or 9cm (maximum) towards the cardia beyond the macroscopically definable border line of the tumor.
Therefore, the probability that cancer cells are left unremoved in the residual stomach after partial resection of the stomach must be considcred to be rather great, and the range of indication for total extirpation of the stomach must be expanded as widely as possible for complete prevention of postoperative recurrence of gastric carcinoma.
(Author's abstract)
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