Significance of para-aortic lymph node dissection in patients with advanced and recurrent gastric cancer.

Among 243 patients who underwent radical gastrectomy for advanced gastric cancer, 19 patients underwent radical gastrectomy with extended lymphadenectomy including cancer-positive para-aortic lymph nodes. Their prognosis was unexpectedly good, with a mean postoperative survival time of 24.1 months and a 2-year-survival rate of 42.4 percent. Another 4 patients developed para-aortic lymph node recurrence detected by computed tomographic scan during a follow-up examination. These 4 patients were treated with macroscopic curative dissection of the para-aortic lymph nodes. Although 2 of the 4 patients died within 6 months after re-operation, the prognosis of the other two patients was rather good when treated with active combination chemotherapy consisting of 5-fluorouracil, adriamycin and cisplatin. Dissection of para-aortic lymph nodes is considered of valuable in the treatment of advanced gastric cancer, and dissection of the para-aortic lymph node recurrence may also be valid when combined with potent chemotherapy.