J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 1510KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 87(9): 1209-1212, 1986

Report on the annual meeting

SURGICAL TREATMENT OF ADVANCED GASTRIC CANCER－LYMPH NODE REMOVAL AND PROPHYLAXIS OF PERITONEAL RECURRENCE

The First Department of Surgery, Tottori University, Yonago, Japan

Nobuaki Kaibara, Michio Maeta, Ryuichi Hamazoe, Yasuo Iitsuka, Shigemasa Koga

The 5-year survival of gastric cancer patients with serosal invasion was not improved even by more extensive lymph node removal (R3-removal) than secondary lymph node removal (R2-removal). In these patients, free cancer cells were frequently detected in the peritoneal cavity by means of Douglas lavage. Free cancer cells which exfoliate from the serosal surface of primary lesion presumably embed on the remote peritoneal surface and proliferate, giving rise to peritoneal metastasis.
To improve the therapeutic result of patients with advanced gastric cancer, a great deal of efforts should be made on the prophylaxis of peritoneal recurrence rather than extensive lymph node dissection. We divised a hyperthermic therapy (continuous hyperthermic peritoneal perfusion, CHPP) combined with surgery for gastric cancer to prevent peritoneal metastasis. The cumulative survival rate in patients receiving CHPP was higher than that of the controls.
Based on the above, we suggest that in advanced gastric cancer with serosal invasion, selective removal of Group 3 lymph nodes according to the location of the primary cancer lesion is superior to uniform R3-removal, and prophylactic treatment for peritoneal metastasis promises better outcome.

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