Incidence of nodal metastasis around the superior border of the pancreas based on number of metastatic perigastric nodes

Abstract

Lymph nodes along the superior border of the pancreas are not usually dissected in Western countries. The purpose of this study was to determine whether the number of metastatic perigastric nodes is predictive of supra-pancreatic nodal disease. Supra-pancreatic nodes are the nodes along the left gastric, common hepatic, celiac, or splenic arteries, including the splenic hilum. In 1230 gastric carcinoma patients treated from 1985 through 1991 at the National Cancer Center Hospital, Tokyo, by D2 or more extensive dissection, 475 had nodal metastasis. Nodal involvement was limited to the perigastric nodes alone in 240 patients, while supra-pancreatic node metastasis was observed in 235 patients. We examined the nodal status of supra-pancreatic nodes in relation to the number of metastatic perigastric nodes. When the number of metastatic perigastric nodes was 3-6, 7-9, and 10 and more, the incidence of metastasis in nodes along the superior border of pancreas exceeded 30%, 50%, and 80%, respectively. When lymph nodes outside the perigastric area are not dissected, the likelihood of residual nodal disease can be predicted based on the number of involved perigastric lymph nodes. The 5-year survival rate in patients with supra-pancreatic node metastasis was high, at 39.2 % after systematic node dissection. If the number of perigastric metastatic nodes exceeds three, supra-pancreatic nodal dissection should be considered.