Early Gastric Carcinoma with Paraaortic Lymph Node Metastasis

Among 373 patients with early gastric carcinoma invading the submucosal layer (SM carcinoma), we studied the clinicopathological findings of 3 patients with paraaortic lymph node metastasis (4.5% of SM car-cinoma with lymph node metastasis), that is, (1) macroscopic mimicking advanced gastric carcinoma, (2) larger tumor size, (3) marked lymphatic vessel invasion and poorly differentiated adenocarcinoma, (4) more metastasis to lymph nodes, and (5) smaller metastatic lymph nodes. It should be noted that it is difficult to evaluate lymph node metastasis by lymph node size. These cases died of liver or peritoneal metastasis in no more than 14 months after operation. It is difficult for these cases to treat curatively by means of extended lymph node dissection. An excessive lymphatic spread case is expected for effectiveness of chemotherapy. These cases require surgery and chemotherapy should be performed. In case of macroscopical SM carcinoma, it will not be necessary for paraaortic lymph node dissection.