[The indication for lymph node dissection around abdominal aorta in gastric cancer]

In 77 cases with gastric cancer, for which lymph node dissection around the left renal vein was performed in the past 5 years, the sites and routes of metastasis were investigated to determine the indication for dissection around the left renal vein. The rate of metastasis to the lymph nodes around the left renal vein was 23.4%. The typical routes of metastasis were 1) the left lower phrenic route, 2) via the splenic artery, 3) via the celiac artery, 4) via the superior mesenteric artery and 5) the postpancreatic route. Dissection was considered to be indicated for the patient with N2 or more distant lymph node involvement and for cases with carcinoma of the upper part of the stomach or whole stomach with N2 positive lymph node. It was also indicated for N3(+) cases or No. 9(+) cases of carcinoma of the middle and lower parts of the stomach. Needless to say the absence of other non curative factors is required.