[Investigate on rational lymph-node dissection for gastric cardia cancer]

To investigate the rule of lymph-node metastasis in gastric cardia cancer and the rational extent of lymph node dissection.

Clinicopathological data of 77 patients with gastric cardia cancer were reviewed and the relationship between extent of lymph-node dissection and prognosis was analyzed retrospectively.

(1) The lymph node metastasis rates were 64.9% for N(1), 14.3% for N(2) and 10.4% for N(3). (2) No lymph node metastasis was detected in T(1) stage tumor and maximum diameter of less than 2.0 cm. The lymph node metastasis rates were 20% for T(2), 68.2% for T(3) and 82.8% for T(4) respectively. (3) Lymph node No.1, 3, 2 were often involved in the metastasis of lymph node group 1, and No.7, 8, 10, 9 in Group 2. In lymph node group 3, lymph node metastasis rates were 6.5% for No.5, 1.3% for No.6, 1.3% for No.16 and 2.6% for No.107-110. (4) The five-year survival rates were 36.5% for D(3), 31.3% for D(2), and 22.7% for D(1) lymphadenectomy respectively. The survival rates of patients undergone D(2) and D(3) lymphadenectomy were significantly higher than that undergone D(1) dissection (P<0.05).

D(2) or more than D(2) lymphadenectomy associated with enlargement of esophageal hiatus via laparotomy, lower partial esophagectomy and total gastrectomy is able to achieve surgical resectability and improve the survival rate of gastric cardia cancer patients.