Incidence and prognosis of N4 node involvement in gastric cancer

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Abstract
We have undertaken a prospective study of the frequency and prognosis associated with N4 node metastases in gastric cancer in 136 patients referred for surgical treatment between 1976 and 1983. N4 node metastases (pre‐aortic or hepatic hilar nodes) were present in 20 of 31 patients who had a laparotomy without resection (64 per cent), in 2 of 8 patients who had a “palliative” resection in the presence of distant metastases (25 per cent) and, in 19 of 85 patients who had a “curative” resection (22 per cent). The median survival in patients having a “curative” resection with N4 nodes was 4.5 months which was only marginally longer than in patients having a “palliative” resection (median survival 3 months). In view of these findings and since immediate imprint cytology can be used to detect nodal metastases at operation, involvement of N4 nodes might be a contra‐indication to extensive gastric resection in non‐obstructing gastric cancer.