Lymphatic Flow Using Activated Carbon Particle in Lymph Node Metastasis and Skip Metastasis in Gastric Cancer

Chikara Kunisaki, Hiroyuki Yamaoka, Junichi Wakasugi, Masazumi Takahashi, Yasuhiro Koizumi, Hirotoshi Akiyama, Daisuke Minabe, Osamu Kunihiro, Noriomi Hosaka, Hiroshi Shimada

Second Department of Surgery, School of Medicine, Yokohama City University

To determine lymphatic flow in gastric cancer, the rate of staining of regional lymph nodes agter injecting activated carbon particles (CH40) into the gastric subserosal layer was investigated in 78 patients who underwent dissection of para-aortic lymph nodes. The staining rate of lymph nodes without metastasis was significantly higher than that of lymph nodes with metastasis. The main lymphatic flow draining from the lower third region streamed through No. 6 to Nos. 14v and 16 and through No. 3 to Nos. 7,9 and 16. In the No. 16 lymph nodes, the highest staining rate was observed in No. 16a₁, bilaterally. In the n₁ cases, lymphatic flow directly streamed to No. 5 and 6 across No. 3 and 4d, respectively, due to obstruction of ordinary lymphatic flow. The main lymphatic flow draining from the middle third region streamed thorough No. 3 to 7, 9 and 16. In the n₁ cases lymphatic flow directly streamed to No. 4sa, 5 and 2 across No. 3, 4sb and 4d. The main lymphatic flow draining from the upper third region streamed through No.2 to 16 and through No. 4sa to 10, 11 and 16 but lymphatic flow to Nos. 8p, 12 and 14v was less apparent. In the No. 16 lymph nodes, the highest staining rate was observed in No. 16a₂, lateroaortic lymph nodes. No. 16 lateroaortic lymph nodes was considered to be the second degree lymph node in the upper third region. In the n₁ cases, lymphatic flow changes to No. 7 across No. 1 and 3. The pattern of lymphatic flow with skip metastasis to para-aortic lymph nodes was similar to that in consecutive metastasis and so the concept of "skip metastasis" would be the distortion due to the general rules for the gasric cancer study. To improve the surgical results in gastric cancer, the classification of lymph node should be divided accoring to the frequency of metastasis and effectiveness of lymph node dissection not to anatomical location and so appropriate operations based on knowledge of lymphatic flow should be performed.

Key words
gastric cancer, lymphatic flow of the stomach, lymph node metastasis of gastric cancer, CH40

Reprint requests
Chikara Kunisaki Second Department of Surgery, Yokohama City University School of Medicine
3-9 Fukuura, Kanazawa-ku, Yokohama, 236 JAPAN

Accepted
June 11, 1997

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