Rationale for Dissection of Lymph Node Associated with Gastric Carcinoma Located at the Greater Curvature of the Stomach -The Correlation Between the Pattern of Lymph Node Metastasis and the Distribution of Blackened Lymph Nodes by Vital Staining Using Activated Carbon Particles (CH40)-

Noboru Nakagawa

First Department of Surgery, Kyoto Prefectural University of Medicine

The pattern of lymph node metastasis of 941 patients with gastric cancer who had undergo gastrectomy was analyzed. During the operation of 78 of these patients activated carbon particles (CH40) were injected the subserosa of the stomach and the pattern of lymph nodes which were blackened by CH40 was observed. Since the main lymphatic flow from the greater curvature of the upper third of the stomach drains through lymph nodes via the splenic artery and para-aortic nodes around the left renal vein, it is generally recommended that the entire stomach, distal pancreas, spleen and para-aortic lymph nodes be resected en bloc if this region is cancerous. With respect to cancers of the greater curvature of the middle third of the stomach, the main lymphatic flow is known to drain through the lymph nodes along the right and/or left gastroepiploic arteries. If this form of cancer shows metastasis within the lymph nodes along the right gastroepiploic artery, the pattern of the metastasis is similar to that observed in cancer of the greater curvature of the lower third of the stomach. Alternatively, if the cancer has metastasized to lymph nodes along the left gastroepiploic artery, the metastatic pattern appears to be similar to that of the upper third of the stomach. Since the main lymphatic flow from the greater curvature of the lower third of the stomach drains primarily into the infrapyloric lymph nodes, followed by drainage into lymph nodes along the common hepatic artery, and at the root of the superior mesenteric vein, as well as within the hepatoduodenal ligament and along the splenic artery, it is recommended that subtotal gastrectomy together with radical resection of all these lymph nodes be performed for cancer of this region.

Key words
lymphatic flow from the greater curvature of the stomach, lymph nodes metastasis of gastric carcinoma located at the greater curvature, activated carbon particles (CH40)

Reprint requests
Noboru Nakagawa First Department of Surgery, Kyoto Prefectural University of Medicine
Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602, JAPAN

Accepted
June 17, 1992

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