RESULTS OF CURATIVE GASTRECTOMY FOR CARCINOMA OF THE DISTAL 1 3 OF THE STOMACH/

BACKGROUND: Carcinoma of the distal stomach metastasizes to lymph node s along the bile duct, pancreatic head, and duodenum. We reviewed the results of patients who underwent operation for carcinoma of the stoma ch, and placed special emphasis on survival related to lymph node meta stasis. STUDY DESIGN. We conducted a prospective study of 258 consecut ive patients with adenocarcinoma of the distal third of the stomach wh o underwent curative gastrectomies. RESULTS: Most of the patients (193 [75 percent]) had advanced cancer (extension beyond the submucosa). A subtotal gastrectomy was the procedure most commonly performed (89 pe rcent). Combined organ resection was performed in 100 patients (39 per cent). The operative morbidity was 17 percent; the most frequent compl ications were chylous leakage, anastomotic insufficiency, and intra-ab dominal infection. Ninety-four patients (36 percent) had tumor recurre nce, with local recurrence occurring in 45 patients. In 40 of the 45 c ases, the local recurrence resulted from remnant lymph nodes (LNs), or soft tissues in the gastric bed, Lymph node metastases were observed in 152 patients (59 percent). Excluding five patients (2 percent) who died, the overall five-year cumulative survival rate was 53 percent. T he five year survival rate was 98 percent for patients with TNM stage I disease; 68 percent for patients with stage II disease; 40 percent f or patients with stage III disease; and 10 percent for patients with s tage IV disease. The survival rate for patients with n0, n1, n2, and n 3 disease was respectively 92 percent, 45 percent, 30 percent, and 20 percent. For patients with metastatic LNs in the hepatoduodenal ligame nt, the five-year survival rate was 20 percent. CONCLUSIONS: These dat a suggest that survival rate relates to the extent of LN metastasis. I t appears that systematic lymph node dissection may have a beneficial effect. However, the efficacy of radical lymph node dissection can onl y be determined by prospective, randomized clinical trials with a prop er study design.