Clinical Significance of the Pattern of Lymph Node Metastasis Depending on the Location of Gastric Cancer

Abstract

PurposeWhen performing a laparoscopic assisted gastrectomy, a function-preserving gastrectomy is performed depending on the location of the primary gastric cancer. This study examined the incidence of lymph node metastasis by the lymph node station number by tumor location to determine the optimal extent of the lymph node dissection.Materials and MethodsThe subjects consisted of 1,510 patients diagnosed with gastric cancer who underwent a gastrectomy between 1996 and 2005. The patients were divided into three groups: upper, middle and lower third, depending on the location of the primary tumor. The lymph node metastasis patterns were analyzed in the total and early gastric cancer patients.ResultsIn all patients, lymph node station numbers 1, 2, 3, 7, 10 and 11 metastases were dominant in the cancer originating in the upper third, whereas station numbers 4, 5, 6 and 8 were dominant in the lower third. In early gastric cancer patients, the station number of lymph nodes with a metastasis did not show a significant difference in stage pT1a disease. On the other hand, a metastasis in lymph node station number 6 was dominant in stage pT1b disease that originated in the lower third of the stomach.ConclusionsWhen performing a laparoscopic-assisted gastrectomy for early gastric cancer, a limited lymphadenectomy is considered adequate during a function-preserving gastrectomy in mucosal (T1a) cancer. On the other hand, for submucosal (T1b) cancer, a number 6 node dissection should be performed when performing a pylorus preserving gastrectomy.

Pylorus-preserving gastrectomy for early cancer involving the upper third: can we go higher?

“…Data showed sufficient safety for LN station #2 for the early cancers located in midbody and high body. A previously published study also showed low metastatic rate of these LN stations in middle or upper third EGC [32]. As a confirmation of this concept, the TG cases of this study with upper third involved tumor location, but tumor border of > 3 cm apart to EGJ had metastasis to each LN station similar to abovementioned database cases (no LN metastasis in LN station #2).…”

Characterization of lymph node metastasis and its clinical significance in the surgical treatment of gastric cancer

“…The M lymphatic drainage has the characteristics of both U and L. The perigastric lymphatic drainages eventually flow into the lymph nodes surrounding the abdominal aorta. That study also reported that the characteristics of lymph node metastasis in gastric cancer generally follow the way of lymphatic drainage, which is consistent with previously reported findings (20). Several studies demonstrated that, for advanced gastric cancer, D2 dissection may significantly improve the patients' survival rate, whereas the number of removed lymph nodes is also significantly correlated with prognosis (21,22).…”

“…4 lymph nodes was >20%. Han et al (20) reported that the incidence of metastasis in station no. 4 lymph nodes in patients with proximal gastric cancer was ~12.6%.…”

Adequacies of lymphadenectomy range for gastric cancer according to the second and third/fourth Japanese gastric cancer treatment guidelines

“…Stations were considered mandatory for dissection (1) if the frequency of LN metastasis was ≥ 1% in EGC cases or (2) patients with positive LNs and AGC had a 5-year survival rate of ≥ 20%. In some papers investigating the frequency of LN metastasis in EGC, the incidence of perigastric lymph nodes was reported to be 1.2%-7%, suggesting that more than 1% of LN metastasis woule be suitable for mandatory dissection [16][17][18][19]. Also in our hospital data, 5-year survival after curative resection of gastric cancer showed that stage IIIa was 53.9%, IIIb was 36.5%, and IV was 23.9%.…”