Lymph node removal for advanced gastric cancer with special reference to peritoneal metastasis.

The 5-year survival rate of gastric cancer patients was evaluated in relation to cancer infiltration to the gastric serosa, lymph node metastasis and lymph node removal, the pattern of cancer recurrence, and the presence of free cancer cells in the peritoneal cavity. The 5-year survival of patients with cancer infiltration to the gastric serosa was not improved even by more extensive lymph node removal (R3 removal) than secondary lymph node removal (R2 removal). In these patients, viable free cancer cells were detected in the peritoneal cavity. In patients with cancer recurrence, peritoneal metastasis was often present within 2 years of curative surgery. Based on our present results, we suggest that in advanced gastric cancer with marked serosal invasion, selective removal of more distant lymph nodes than secondary lymph nodes according to the location of the primary cancer lesion should be carried out in addition to R2 removal and that this selective removal is superior to uniform R3 removal.