LYMPH-NODE METASTASIS AND SURGICAL-MANAGEMENT OF GASTRIC-CANCER INVADING THE ESOPHAGUS

In 88 resected patients with esophagus-invading gastric cancer, the fa ctors determining the prognosis of this disease were investigated by m ultivariate analysis. Neither, age, sex, macroscopic type, thoracotomy , nor histological type proved to be independent prognostic factors. T he presence or absence of lymph node metastasis, serosal invasion, tum or size, and the extent of esophageal invasion were found to be signif icant independent prognostic factors. Among lymph node metastases, inv olvement of para-aortic lymph nodes was especially important. The prog nosis was significantly better in cases in which these nodes were care fully dissected (R4 gastrectomy), than in cases in which selected diss ection was performed (R2). However, no patient with mediastinal lymph node metastasis survived for any lengthy period, and thus the mediasti nal lymph nodes seemed to be nodes, the dissection of which brought li ttle effect. Postoperative results were very poor in cases in which th e extent of the esophageal invasion was 3 cm or more. These patients s hould be treated with multi-modal therapy such as neoadjuvant chemothe rapy.