The Study of Lymphatic Routes to the Abdominal Para-aortic Lymph Nodes and the Significance of these Lymph Node Dissection for Advanced Gastric Cancer

Atsushi Nashimoto, Juei Sasaki, Sadahiko Akai

Division of Surgery, Niigata Cancer Center Hospital

We studied the main gastric lymphatics from the stomach to the abdominal para-aortic lymph nodes (No. 16) by means of direct injection of the activated carbon particle (CH44) into the reglonallymph nodes during surgery in 35 patients, and endoscopic injection of the CH44 into the gastric submucosal layer around the cancer lesion before surgery in 102 patients. We found 2 main lymphatic routes, subdivided into 3 routes as follows; (1) Left side routes were via the celiac artery, the splenic artery, and the left subphrenic artery, and (2) Right side routes were via the mesenteric vessels, the celiac artery, and retropancreatic route. The percentages of black stained No. 16 nodes were high in "lateral a2" nodes of cardiac cancer (56.5%) and in "inter b1" nodes of antral cancer (60.0%). We also studied the frequency and prognosis associated with No. 16 lymph node metastases in gastric cancer in 312 patients referred for surgical treatment between 1974 and 1988. The No. 16 node metastatic rate was 25% (78/312), and it was high in lateral a, b1 and inter b1 nodes of cardiac cancers, and in inter b1 and lateral b1 nodes of antral cancers. No. 16 nodes should be dissected for N3, or S2 and N2, or S3 cases except for absolute non-curative cases. The 5-year survival rate for P (-) and H (-) patients who underwent relative non-curative resection was 23.1%, and that for patients with one or two positive No. 16 nodes was 23.3%, suggesting that dissection of No. 16 nodes was significant for these cases.

Key words
para-aortic lymph node dissection for advanced gastric cancer, main lymphatic routes to the para-aortic lymph nodes, retroperitoneal approach, remote survival

Reprint requests
Atsushi Nashimoto Division of Surgery, Niigata Cancer Center Hospital
2-15-3 Kawagishi-cho, Niigata, 951 JAPAN

Accepted
January 16, 1991

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