Lymph Node Dissection of the Paraaortic Area in Gastric Cancer Operations around the Aortic Hiatus: Views during Surgery and Cadaveric Dissection

Kazuhiko Yamada, Shigekazu Ohyama, Keiichiro Ohta, Toshiki Matsubara, Toshiharu Yamaguchi and Tetsuichiro Muto

Department of Gastroenterological Surgery, Cancer Institute Hospital

Purpose: We clarified the difference between surgical and cadaveric views of paraaortic dissection around the aortic hiatus in gastric cancer patients. Material and Methods: The pathway of the lymphatic trunk and its relationship to the thoracic duct and the cisterna chyli was studied in 38 postmortem cadaver specimens and 16 intraoperative specimens. Results: In cadaver specimens, most of the lymphatic trunk passed through the aortic hiatus. The average number of lymphatic trunks was 2.07 on the left and 1.16 on the right. In 4 specimens (11%), however, there were some thin lymphatic vessels that did not pass through the aortic hiatus. The incidence of the cisterna chyli is 2 specimens (5%). In surgical specimens, most thick lymphatic trunks passed through the aortic hiatus. In 4 specimens (25%), however, the thick lymphatic trunk did not pass through the aortic hiatus. Conclusion: We conclude that the main lymphatic pathway passes into the thoracic duct through the aortic hiatus. In paraaortic dissection during gastric cancer surgery, it is important to note that the aortic hiatus is behind the bilateral renal artery. Another thin lymphatic vessel is located between the median and internal bundle of the diaphragmatic crus that does not pass through the aortic hiatus. Care is thus needed in noting the difference in the number and pathway of lymphatics between surgical and cadaveric views of paraaortic dissection around the aortic hiatus.

Key words
gastric cancer, paraaortic lymph node dissection, lymphatic trunk, cadaveric view, aortic hiatus

Reprint requests
Kazuhiko Yamada Departmento of Gastroenterological Surgery, Cancer Institute Hospital 1-37-1 Kami-Ikebukuro, Toshima-ku, Tokyo, 170-8455 JAPAN

Accepted
February 26, 2003

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