Reliability of intraoperative macroscopic evaluation of lymph node metastasis and effectiveness of lymphadenectomy in stomach carcinoma

: The aim of this prospectively performed study was to evaluate the accuracy of macroscopic intraoperative lymph node staging by the operating surgeon. 65 patients with histologically proven gastric carcinoma and without previous abdominal operations were included. Carcinomas of the cardia and malignant lymphomas were excluded. Due to the study protocol the surgeon evaluated the lymph node status before beginning the resection. For exact exploration of the compartments II and III the omental bursa had to be opened through the gastrocolic ligament and the lesser omentum had to be cut off from the liver. The resection itself consisted of en bloc total gastrectomy, D2 lymphadenectomy and removal of the lesser and the greater omentum. The operation was completed by the removal of the spleen if necessary. The surgeon thought 85.2% of the N0-patients to be N > 0 and overlooked lymphatic occupation of compartment I in 8.8%, of compartment II in 14.3% and of compartment III in 50%. The histological examination of the resection specimen showed that the surgeon's impression concerning the extent of the lymph node occupation of the complete situs was correct in only 16.9%. The allocation of the macroscopically determined lymph node status to the TNM scheme was correct in 33.8%. It should be concluded from the study that intraoperative macroscopic staging procedures as a basis for therapeutic decisions are to be avoided strictly.