Experimental Study on Lymphatic Flow of the Esophago-gastric Region -Using Cardiac Cancer Model-

Takayuki Matsuo

First Department of Surgery, Kurume University School of Medicine (Director: Prof. Teruo Kakegawa)

We report our investigation, using cardiac cancer models, into the route of metastases to the lymphnodes around the lower part of the mediastinum and the abdominal aorta, and the possibility of lymphagenous advance to the diaphragm. We produced cardiac cancer models by endoscopically transplanting VX₂ carcinoma into the lower esophagus (E>C), the esophago-gastric junction (C≥E), and into the upper stomach (C). We then followed the lymphatic flow using particulate active carbon (CH₄₄). An upward lymphatic flow ascending the paraesophageal route was found in 6 (40%) of the 15 models in the C≥E group, and in 6 (60%) of the 10 in the E>C group, but not found in the C group and not in the controls. A downward lymphatic flow towards the surroundings of the abdominal aorta was observed in 36 (80%) of the 45 models via the left gastric artery and in 12 (27%) of the 45 in the pathway through the inferior phrenic artery. A sideward lymphatic flow towards the diaphragm was observed under the serosa of the diaphragm in 3 (12%) of the 25 models in the C≥E and E>C groups. Notably the upward and sideward flows were considered to reveal the collateral pathways involved in the metastatic advance of the gastric carcinoma. It was further suggested that the region of the esophago-gastric junction and the lymphnodes around the aorta might be closely associated with the lymphatic metastatic flow.

Key words
gastric cancer, cardiac cancer, lymphatic flow, VX₂ carcinoma

Reprint requests
Takayuki Matsuo The First Department of Surgery, Kurume University School of Medicine
67 Asahi-machi, Kurume, 830 JAPAN

Accepted
November 19, 1990

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