ROLE OF INTRAOPERATIVE ASSESSMENT OF LYMPH-NODE METASTASIS AND SEROSAL INVASION IN PATIENTS WITH GASTRIC-CANCER

The clinical diagnoses of nodal status (N) and tumor invasion (T) were performed intraoperatively during 1499 consecutive operations for gas tric carcinoma and compared with subsequent pathologic diagnoses. An a ccurate macroscopic diagnosis of N stage was difficult; overall accura cy was only 56.6%. Intraoperative assessment of T stage (particularly of serosal invasion) was correct for 93.2% of early stages of the dise ase with invasion confined to the mucosa or submucosa (pT1) when the p athologist assessed the T stage in the resected specimen, for 95.6% of advanced tumors invading the serosa (pT3), but for tumors of an inter mediate stage with invasion involving the muscularis propria or the su bserosa (pT2) in only 41.9% of cases. Macroscopic overestimation occur red in 58. 1 % of cases with pT2 tumors, which were characterized by c arcinomas in the upper third of the stomach, tumors larger than 5 cm, carcinomas of the ulcerating type, differentiated adenocarcinomas, tum ors invading the subserosa, and those accompanied by lymph node metast asis or liver metastasis. The overestimated group had a significantly poorer prognosis than the correctly assessed cases (P < 0.05). Since m ultivariate logistic regression analysis showed that the significant r isk factor related to the inaccurate intraoperative assessment of T st age was tumor size, the error in diagnosis may correlate with a greate r degree of tumor spread. Surgeons should decide their therapeutic app roach at the time of surgery on the basis of their intraoperative asse ssment of tumor spread. We recommend extensive surgery followed by ade quate chemotherapy when serosal invasion is suspected at surgery. (C) 1994 Wiley-Liss, Inc.