[Considerations on lymph node excision in the surgery of stomach cancers]

The use of extensive lymphadenectomy is based on a historical comparison of results before 1950, when only subtotal gastrectomy was used, and after 1950 when variably extensive lymphadenectomy was associated to visceral exeresis. At the beginning, we involved neither the retroduodenopancreatic lymph nodes nor the juxtahilar nodes of the hepatic pedicle in this lymphadenectomy, and we actually performed only type R2 lymphadenectomy. After 1965, exeresis was extended to said lymph nodes, thus becoming a type R2-R3 operation. As far as viscéral exeresis is concerned, our indication to extend exeresis has been defined according to the site of the tumor, to the degree of infiltration of the gastric wall and to the histological type, rather than to a principle. Thus we have after used subtotal gastrectomy, with 33.3% survival after five years, 30% after ten years and 29% after 12-15 years for the cases of the first period (R2 lymphadenectomy). With type R2-R3 lymphadenectomy, survival is 35.5% at five years and 32.5% at ten years. Total gastrectomy (always with splenectomy) has been performed in all cases of proximal extension, of juxtacardial and fundal location, of multifocal lesions and of poorly differentiated histological types (86 cases). During the period or R2 lymphadenectomy, we had 33.3% survival at five years and 25% at ten years, vs. 36.2% at five years and 32% at ten years in the second period. In properly indicated subtotal resection, R2 lymphadenectomy extending to some third-level areas provides better survival, with acceptable morbidity and mortality.(ABSTRACT TRUNCATED AT 250 WORDS)