INTRAOPERATIVE MACROSCOPIC EVALUATION OF LYMPH-NODE METASTASES IN GASTRIC-CANCER PATIENTS

The aim of this prospectively performed study was to evaluate the accu racy of macroscopic intraoperative lymph node staging by the operating surgeon. 65 patients with histologically proven gastric carcinoma and without previous abdominal operations were included. Carcinomas of th e cardia and malignant lymphomas were excluded. Due to the study proto col the surgeon evaluated the lymph node status before beginning the r esection. For exact exploration of the compartments II and III the ome ntal bursa had to be opened through the gastrocolic ligament and the l esser omentum had to be cut off from the liver. The resection itself c onsisted of en bloc total gastrectomy, D2 lymphadenectomy and removal of the lesser and the greater omentum. The operation was completed by the removal of the spleen if necessary. The surgeon thought 85.2% of t he NO-patients to be N>O and overlooked lymphatic occupation of compar tment I in 8.8%, of compartment II in 14.3% and of compartment III in 50%. The histological examination of the resection specimen showed tha t the surgeon's impression concerning the extent of the lymph node occ upation of the complete situs was correct in only 16.9%. The allocatio n of the macroscopically determined lymph node status to the TNM schem e was correct in 33.8%. It should be concluded from the study that int raoperative macroscopic staging procedures as a basis for therapeutic decisions are to be avoided strictly.