Clinical Analysis Of Para-aortic Lymph Node Metastasis In Advanced Gastric Carcinoma

Objective:To investigate the pattern of Para-aortic lymph node metastasis and the indication of para-aortic lymph node dissection in advanced gastric carcinomaMethods:Retrospective analysis of our hospital D2 plus para-aortic lymph node dissection (PALD) of 51 cases of advanced gastric cancer ,clinical datas such as gender, age, preoperative complications,preoperative relevant inspection (gastroscope, B ultrasonography,CT), manner and with the way the operation,surgical complications(hemorrhage, anastomotic leakage, obstruction,diarrhea,discharge delays,pancreatitis,pulmonary infection and so on),the clinicpathology and other related information,were analysed to investigate the relationship between clinical pathological factors and para-aortic lymph node metastasis in AGC.Results:14 cases appeared in 16a2, 16b1 of lymph node metastasis in 51 cases,the metastatic rate was 27.45%(14 in 51). 9 cases did not invade serosa layer had no case of N0.16 lymph node metastasis , involved 42 cases of serous layer metastatic rate of 33.33%, serosal involvement and the more serious, N0.16 higher rate of lymph node metastasis.In the lower part of the stomach, central, upper part of the tumor, group of lymph node metastasis rate of N0.16 had no significant statistical difference. When the tumor diameter≥5cm(45%), N0.16 group lymph node metastasis rate was significantly high than the diameter <5cm pm (16.13%).The metastatic rate in infiltration stomach cancer was higher than limitation. The N0.16 lymph node metastatic rate might be obvious increase once the lymph node group N1,N2 were affected, and with the expansion of the scope of lymph node involvement, N0.16 group had a marked increase in the rate of lymph node metastasis.Conclusions:N0.16 lymph node in advanced gastric cancer have a higher lymph node metastasis rate, tumor depth of invasion, tumor site, tumor size and gross type, histological type and differentiation degree and the extent of lymph node metastasis is closely related to pathological factors. Recommends the following circumstances without the liver, peritoneal and other distant metastasis of gastric cancer patients with D2 PALD: (1) cancer involving the serosa layer ; (2) N1,N2 lymph node metastasis ; (3) preoperative imaging or intraoperative detection of abdominal aortic found suspicious lymph nodes metastasis ; (4) advanced poorly differentiated carcinoma;(5) when tumor larger than 5cm in diameter or the tumor is located in the upper stomach, the above conditions can be relaxed;(6) The patients aged should be limited to less than 75-year-old,and no heart, lung, liver, kidney and other vital organ dysfunction in order to protect the safety...