N1期食管鳞癌淋巴结转移规律及预后分析

目的：探讨N1期食管鳞癌淋巴结转移规律及其与预后的关系。方法回顾性分析2005年1月至2008年12月间天津医科大学肿瘤医院行食管癌根治术且术后病理诊断为N1期（1～2枚淋巴结转移）的126例患者的临床及随访资料,分析各组淋巴结转移情况及其对预后的影响。结果126例患者中仅1枚淋巴结转移者70例,2枚淋巴结转移者56例。上纵隔淋巴结、中下食管旁淋巴结、贲门周围淋巴结和胃左动脉旁淋巴结的早期转移率较高,分别为53．8％（14/26）、38．3％（41/107）、34．5％（30/87）和36．8％（39/106）。隆突下淋巴结转移（P＝0．031）和中下食管旁淋巴结转移（P＝0．042）是影响食管鳞癌早期淋巴结转移患者的独立预后因素。隆突下淋巴结转移者5年生存率明显低于其他部位淋巴结转移者（8％比26％,P＝0．004）;而仅中下食管旁淋巴结转移者5年生存率则明显高于其他部位淋巴结转移者（33％比12％,P＝0．029）。结论 N1期食管鳞癌淋巴结易转移至上纵隔、中下食管旁、贲门周围和胃左动脉旁淋巴结等部位,而隆突下及中下食管旁淋巴结转移是N1期患者的独立预后因素。     

微创食管癌切除术后淋巴结转移规律及预后分析

目的淋巴结转移是食管癌转移的主要方式,对食管癌患者预后有重要影响,本文探讨食管癌胸腹二区淋巴结的转移规律。 方法选取2010年1月至2016年10月于山东大学齐鲁医院经微创食管癌切除术(minimally invasive esophagectomy, MIE)治疗的食管癌患者613例,参照日本食管肿瘤研究会(JEOG)淋巴结分区标准清扫淋巴结,统计各组淋巴结的转移率。对2010年1月至2013年10月行MIE治疗的203例食管癌患者进行生存分析。另外410例患者由于术后时间较短,随访数据未列入统计。 结果胸上段食管癌较多发生上纵隔淋巴结转移,其左、右喉返神经旁淋巴结转移率分别高达35.9%、40.7%,均显著高于胸中段和胸下段食管癌;胸中段食管癌既向上发生上纵隔淋巴结转移,又向下发生腹腔淋巴结转移;胸下段食管癌主要向胃周淋巴结转移,其中胃左动脉旁淋巴结转移率最高。单因素分析结果显示,病变长度、肿瘤分化程度、肿瘤浸润深度、淋巴结转移程度是影响食管癌患者预后的相关因素(P< 0.05)。COX多因素回归分析结果显示,肿瘤低分化和淋巴结转移是影响食管癌患者预后不良的独立危险因素(P< 0.05)。 结论手术治疗食管癌应重点清扫双侧喉返神经旁淋巴结和胃左动脉旁淋巴结。     

食管癌切除胃食管颈部吻合与胸腔内吻合的对比分析

目的比较食管癌切除胃食管颈部吻合与胸腔内吻合的手术疗效。方法中下段食管癌患者165例,根据手术方式不同,将其分为两组,胃食管颈部吻合组:73例,经左颈、右胸、上腹正中三切口手术40例,经左胸、左颈二切口手术33例。胸腔内吻合组:92例,经左胸或右胸径路行主动脉弓上吻合47例,弓下吻合45例。比较两组术后并发症的发生率和生存率。结果术后食管胃颈部吻合组残端癌、手术死亡率和吻合口瘘死亡率均低于胸腔内吻合组(P<0.05);两组患者间5年生存率差别无统计学意义(P>0.05);但淋巴结转移阴性和阳性患者5年生存率两组间比较差别均有统计学意义(P<0.05)。结论食管癌切除胃食管颈部吻合术治疗中下段食管癌符合肿瘤根治原则,肿瘤切除彻底,残端癌的发生率和死亡率低。     

Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌淋巴结转移规律及预后分析

目的 探讨Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌淋巴结转移规律及预后分析.方法 选取2013年7月-2017年3月在首都医科大学附属北京友谊医院普外科接受根治性手术并具有完整临床资料的Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌患者65例,主要研究指标为性别、年龄、肿瘤部位、肿瘤大小、大体类型、组织学类型、浸润深度、手术方式、脉管内癌栓、癌结节;采用Logistic回归模型分析淋巴结转移危险因素,Kaplan-Meier法进行生存分析.出院后通过门诊、电话等方式随访,随访截至2017年4月.结果 所有患者淋巴结转移率为63.1％(41/65),各组淋巴结转移中,以第1、2、3、7、11和110组淋巴结转移频次最高,转移率分别为45.3％、32.5％、28.8％、22.5％、19.4％和8.2％;肿瘤最大径＜2 cm淋巴结转移率为0,肿瘤最大径≥2 cm淋巴结转移率为71.9％(P=0.000);早期癌(T1)和进展期癌(T2 ～T4)淋巴结转移率分别为0、12.5％、69.0％和95.2％(P=0.000);分化型淋巴结转移率为45.2％,低于未分化型淋巴结转移率79.4％ (P =0.009);33例患者合并脉管内瘤栓,其中28例(84.8％)伴有淋巴结转移(P=0.001);多因素分析显示,组织学类型及脉管瘤栓是影响Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌淋巴结转移的独立危险因素.65例患者均获得随访,术后随访1 ～45个月,平均18.81个月.生存分析显示,无淋巴结转移者3年总体生存率较合并淋巴结转移者差异无统计学意义(P=0.167),但较合并淋巴结转移者存在生存优势;肿瘤分期对于3年总体生存率差异无统计学意义(P =0.429),但早期肿瘤较进展期肿瘤具有生存优势.结论 Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌淋巴结转移主要与组织学类型及脉管内瘤栓相关;其中第1、2、3、7、11和110组淋巴结转移率高,因而建议行根治性全胃切除术、D2淋巴结清扫术及常规清扫第110组淋巴结或清扫纵隔及食管裂孔周围淋巴结,对于合并淋巴结转移及肿瘤分期晚者,远期预后仍有待进一步研究证实.     

肝内胆管癌的淋巴扩散类型

日本 Kumamoto大学医院曾收治 62例肝内胆管癌 ,不包括 5 6肝门、肝外胆管癌 ,作者对其中 39例肝内胆管癌的手术切除标本进行淋巴结转移和扩散的观察 ,2 4例有淋巴结转移 ,其分布情况如附表所示。附表　原发肿瘤位置和阳性淋巴结分布情况淋巴结组 原发灶位置伴阳性淋巴结 :右肝叶外周 肝门 左肝叶外周肝十二指韧带 3 10 7肝总动脉 15 6主动脉旁 173胰腺后 142胃左动脉 0 3 3肠系膜上动脉 12 2腹腔动脉 12 2胃小弯 0 3 0胃底 0 0 1可见肝内胆管癌能转移至下列淋巴结组 :肝十二指肠韧带 ,沿肝总动脉和腹主动脉 ,胰头的后面 ,沿胃左动脉、肠系…     

术前胸中上段食管癌颈部淋巴结转移相关因素分析

目的分析术前胸中上段食管癌病人发生颈部淋巴结转移的相关因素。方法行食管癌切除+三野淋巴结清扫手术的食管胸中上段癌病人64例,按照是否发生颈部淋巴结转移分为转移组(20例)和未转移组(44例)。比较两组病人的术前临床资料,分析发生颈部淋巴结转移的独立危险因素。结果食管癌病人超声检查结果中淋巴结短径、纵横比、内部回声、RI值与是否发生颈部淋巴结转移关系密切(P0.05);在两组病人的增强CT结果中,发生喉返神经旁淋巴结、胸部淋巴结肿大的比率差异明显,差异有统计学意义(P0.05);短径、RI值诊断颈部淋巴结转移的效能较好,ROC曲线下面积分别为0.823、0.694;Logistic回归分析发现,纵横比≥0.5、喉返神经旁淋巴结肿大为胸中上段食管癌病人发生颈部淋巴结转移的独立危险因素。结论食管胸中上段癌病人颈部淋巴结短径、纵横比、内部回声、RI值、喉返神经旁淋巴结、胸部淋巴结肿大是预测颈部淋巴结转移的重要指标,其中纵横比≥0.5、喉返神经旁淋巴结肿大为胸中上段食管癌病人发生颈部淋巴结转移的独立危险因素。     

胸段食管鳞癌患者的喉返神经旁淋巴结转移特点

目的探究胸段食管鳞癌患者的喉返神经旁淋巴结转移特点。 方法回顾性分析福建协和医院胸外科2012年1月至2015年12月间收治的行胸腹腔镜联合食管癌切除术的294例胸段食管鳞癌患者的喉返神经旁淋巴结清扫及转移情况,并分析喉返神经旁淋巴结转移特点。 结果294例行喉返神经旁淋巴结清扫的患者中,有88例患者有喉返神经旁淋巴结转移,转移率为29.93%;共清扫喉返神经旁淋巴结1 899枚,转移淋巴结145枚,转移度为7.64%。胸段食管鳞癌患者左、右喉返神经旁淋巴结转移与肿瘤浸润深度、分化程度、脉管瘤栓均有显著相关性(P<0.05),但与性别、年龄、肿瘤部位无显著相关性(P>0.05)。 结论胸段食管鳞癌患者易发生喉返神经旁淋巴结转移。对于肿瘤浸润程度大、分化程度差、有脉管瘤栓的胸段食管鳞癌患者,应重视左、右两侧喉返神经旁淋巴结清扫。     

食管床内食管胃吻合术的体会

１９８１年初至１９９８年底对１０３例食管癌患者行左侧开胸，食管部分切除，胃经食管床在弓上８４例或颈部１９例行食管胃吻合，收到满意的临床效果，现报道如下。临床资料本组男性７８例，女性２５例，年龄３２～７８岁。病变部位中段４６例、中下段４４例、中上段９例、上段４例；病变范围４～１１ｃｍ。经病理检查，鳞癌１０１例，食管胃黑色素瘤１例，鳞癌兼黏膜下平滑肌瘤１例。手术方式经左胸侧后第６肋或第５肋切口，游离胸段食管及清除周围淋巴结，充分游离全胃达幽门，清扫胃左动脉周围淋巴结，断胃后在胃底最高处作３ｃｍ长切口…     

不同术式治疗食管中下段癌的临床研究

目的 比较不同术式治疗食管中下段在手术创伤、恢复和淋巴结清扫方面的差异.方法 59例食管中下段癌病人接受食管癌切除手术.根据手术入路的不同,被分为3组:右胸、腹两切口手术组(两切组),右胸、腹、左颈三切口手术组(三切组)及左胸入路手术组(左胸组).收集临床数据并进行统计学分析.结果 手术切除率100%,无围手术期死亡.两切组、三切组和左胸组在术后住院时间、术后全身炎症反应综合征时间、体液丢失总量方面差异无统计学意义(P=0.287、0.641和0.355).3组的淋巴结清扫中位总数分别为22.5(11-39)枚、26(14-56)枚和17(7-44)枚(P=0.005);腹腔淋巴结清扫总数分别为10(5-26)枚、12(4-31)枚和8(3-19)枚(P=0.021).胸腔淋巴结清扫数目3组之间差异无统计学意义(P=0.177).食管中、下段癌淋巴结最常转移部位依次为贲门周、中段食管旁、胃左动脉旁等.经右胸食管癌手术的淋巴结清扫范围更广.结论 在创伤和整体恢复方面,左胸手术和右胸手术之间没有显著差异,而右胸手术组淋巴结清扫总数更多.由于食管中下段癌的淋巴结转移范围广泛,应该进行更认真、彻底的淋巴结清扫工作,以期降低局部复发率并改善生活质量.     

进展期食管胃结合部腺癌根治性切除术后复发转移的危险因素分析

目的 探讨影响进展期食管胃结合部腺癌根治性切除术后复发转移的危险因素.方法 回顾性分析2000年1月至2007年1月天津医科大学附属肿瘤医院行根治性切除术的385例食管胃结合部腺癌患者的临床资料.其中228例患者术后无复发转移(无复发转移组),157例患者出现复发转移(复发转移组).通过门诊或电话方式进行随访,了解患者生存情况,随访时间截至2012年9月.单因素及多因素分析探讨可能影响患者术后发生复发转移的危险因素.术后复发转移的单因素分析采用x2检验,再将单因素分析中有统计学意义的变量纳入Logistic回归模型进行多因素分析;采用Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验.结果 术后随访时间为3～ 108个月,中位随访时间为36个月.全组患者术后157例发生肿瘤复发转移,肿瘤平均复发时间为根治性切除术后17.9个月.单因素分析结果显示:大体分型、分化类型、浸润深度、阳性淋巴结数目、阴性淋巴结数目及TNM分期有统计学意义(x2=5.248,13.493,12.319,18.315,9.704,10.281,P＜0.05).多因素分析结果显示:分化类型、浸润深度、阳性淋巴结数目及阴性淋巴结数目是食管胃结合部腺癌根治性切除术后复发转移的独立危险因素(OR=1.805,1.809,1.520,0.763,P＜0.05).无复发转移组和复发转移组患者的阳性淋巴结数目分别为(3.86±0.28)枚和(6.89±0.58)枚,两组比较,差异有统计学意义(t=5.118,P＜0.05);无复发转移组和复发转移组患者的阴性淋巴结数目分别为(14.04±0.54)枚和(10.53±0.56)枚,两组比较,差异有统计学意义(t=4.386,P＜0.05).阳性淋巴结数目为0、1～2、3～6、≥7枚的患者5年生存率分别为46.4％、43.8％、27.1％、7.2％,中位生存时间分别为53、47、35、26个月,不同阳性淋巴结数目患者5年生存率比较,差异有统计学意义(x2=54.783,P＜0.05);阴性淋巴结数目为＜9、10 ～15、≥16枚的患者5年生存率分别为22.1％、21.5％、45.5％,中位生存时间分别为28、34、47个月,不同阴性淋巴结数目患者5年生存率比较,差异有统计学意义(x2=22.814,P＜0.05).结论 肿瘤的分化类型、浸润深度、阳性和阴性淋巴结数目是食管胃结合部腺癌根治性切除术后复发转移的独立危险因素,其中阳性和阴性淋巴结数目对患者预后的影响具有重要意义.     

Distribution of Lymph Node Metastasis Including Micrometastasis in Gastric Cancer with Submucosal Invasion

Abstract The purpose of this retrospective study was to analyze the distribution of lymph node metastases, including micrometastases, according to the location of the gastric cancer with submucosal invasion. A total of 118 patients with submucosal gastric cancer were enrolled in this study. The distribution of lymph node metastases was examined according to tumor location. Immunohistochemical examination using anti-cytokeratin antibody was performed to examine nodal micrometastases in 118 patients. Lymph node metastasis was found in 19.5% (23/118) of the patients. Significant differences were found for tumor size and depth, lymphatic invasion, and venous invasion for patients with and without nodal metastasis. The distribution of lymph node metastasis for tumors at upper or middle portions of the stomach was mainly found along the left gastric artery. The distribution of lymph node metastasis for tumors in the lower and lesser curvature varied. Immunohistochemical analysis found that 15 of 23 patients with lymph node metastasis found by histologic examination had micrometastases. The presence of two or more lymph node micrometastases was found in these 15 patients, and they were distributed in another stations, including distant nodes. The incidence of micrometastasis was 24.2% (23/95) in pN0 patients. Lymph node micrometastases were confined to regional nodes near the primary tumor. When planning minimally invasive treatment for submucosal gastric cancer, it is important to understand the distribution of lymph node metastasis, including micrometastasis, according to tumor location.     

Pattern of lymph node metastases in patients with squamous cell carcinoma of the thoracic esophagus who underwent three-field lymphadenectomy

BACKGROUND/AIMS: Lymph nodes in patients with squamous cell carcinoma of the thoracic esophagus might be involved with metastases at cervical, mediastinal, and abdominal sites. The range of lymph node dissection is still controversial. The pattern of lymph node metastasis and factors that are correlated with lymph node metastasis affect the surgical procedure of lymph node dissection. The purpose of the present study was to explore the pattern of lymph node metastasis and factors that are correlated with lymph node metastasis in patients with esophageal cancer who underwent three-field lymphadenectomy. METHODS: Lymph node metastases in 230 patients who underwent radical esophagectomy with three-field lymphadenectomy were analyzed. The metastatic sites of lymph nodes were correlated with tumor location by chi-square test. Logistic regression was used to analyze clinicopathological factors related to lymph node metastasis. RESULTS: Lymph node metastases were found in 133 of the 230 patients (57.8%). The average number of resected lymph nodes was 25.3 +/- 11.4 (range 11-71). The proportions of lymph node metastases were 41.6, 19.44, and 8.3% in neck, thoracic mediastinum, and abdominal cavity, respectively, for patients with upper thoracic esophageal carcinomas, 33.3, 34.7, and 14%, respectively, in those with middle thoracic esophageal carcinomas, and 36.4, 34.1, and 43.2%, respectively, for patients with lower thoracic esophageal carcinomas. We did not observe any significant difference in lymph node metastatic rates among upper, middle, and lower thoracic carcinomas for cervical or thoracic nodes. The difference in lymph node metastatic rates for nodes in the abdominal cavity was significant among upper, middle, and lower thoracic carcinomas. The lower thoracic esophageal cancers were more likely to metastasize to the abdominal cavity than tumors at other thoracic sites. A logistic regression model showed that depth of tumor invasion and lymphatic vessel invasion were factors influencing lymph node metastases. CONCLUSIONS: Based on our data, cervical and mediastinal node dissection should be performed independent of the tumor location. Abdominal node dissection should be conducted more vigorously for lower thoracic esophageal cancers than for cancers at other locations. Patients with deeper tumor invasion or lymphatic vessel invasion were more likely to develop lymph node metastases.     

胃癌哨兵淋巴结位置分布及其转移相关因素

目的　探讨胃癌哨兵淋巴结位置分布规律以及导致其转移的相关因素。方法　调查2 7例单个转移淋巴结、80例单组转移淋巴结的位置分布 ,比较单个转移淋巴结和 111例无转移淋巴结病人的临床病理参数。结果　 2 7个单个转移淋巴结中有 2 5个位于第 1站 ,跳跃转移 2个 ;2 1例胃下区、胃中区癌哨兵淋巴结中 16个在第 3、4组 ,6例胃上区癌哨兵淋巴结中 3个位于第 1组。pT3 期胃癌哨兵淋巴结转移的危险性高于pT1胃癌 ,比数比 (OR)为 4 92 6 (P <0 0 1) ,胃上区癌比胃下区癌哨兵淋巴结更易发生转移 (OR =4 381,P <0 0 5 ) ,早期胃癌哨兵淋巴结的转移危险性低于BorrmannⅠ型胃癌 (OR =0 0 82 ,P <0 0 5 )。结论　胃癌哨兵淋巴结多位于肿瘤附近 ,跳跃转移少见 ;肿瘤侵犯深度以及所在部位与哨兵淋巴结发生转移有关 ,利用胃癌哨兵淋巴结可以指导胃癌淋巴结切除范围的选择     

进展期胃癌的淋巴结转移特点及其临床意义

目的探讨进展期胃癌的淋巴结转移特点及临床意义。方法对2002年4月至2003年7月期间进行胃癌根治淋巴结清扫手术的91例患者的手术切除标本进行解剖，收集切除的淋巴结，逐枚进行病理组织学和免疫组织化学检查，判断淋巴结是否转移并计算淋巴结转移率。分析淋巴结转移率与肿瘤大小、TNM分期、Borrmann分型、肿瘤部位和淋巴结清扫范围等方面的关系。结果91例胃癌患者中淋巴结转移阳性63例（69．2％）。共收获3149枚淋巴结，平均每例34．6枚。肿瘤直径小于3cm者淋巴结转移率较3cm以上者低（P〈0．05）。TNM分期中Ⅲa和Ⅳ期患者淋巴结转移率均为100％，其转移度在30．3％～58．4％之间，较Ⅰ、Ⅱ期者高（P〈0．001）；Borrmann分型中Ⅲ型病例的淋巴结转移率（79．6％）较其他型患者高，而Ⅳ型患者淋巴结转移度（35．3％）最高（P〈0．05）。施行D3淋巴结清扫手术患者的淋巴结转移率和转移度（88．2％、38．0％）均高于D1、D2术患者（P〈0．05）。17例（18．7％）患者常规病理检查发现有183枚淋巴结微转移，肿瘤各部位与淋巴结微转移的关系差异无统计学意义（P〉0．05）。近端胃癌淋巴结转移主要在第1、2、3、5、7、8、9、12、13和16组，以8组转移度为最高（68．1％）；中部胃癌淋巴结转移主要在第1、3、7、12、13和16组，其中最高转移度为第3组（47．6％）；远侧胃癌淋巴结转移主要见于1、2．3、5、6、12、13和16组，其中第16组转移度为最高（83．3％）。结论淋巴结转移率和转移度与胃癌的恶性程度密切相关，因此D3淋巴结清扫手术对某些进展期胃癌患者值得考虑使用。     

胸段食管癌淋巴结转移特点的临床研究

目的 探讨胸段食管癌淋巴结转移的规律和特点,从而为其手术入路和淋巴结清扫范围提供参考.方法 回顾性分析2009年1月至2012年12月间中南大学湘雅医学院附属肿瘤医院胸外科收治的72例胸段食管癌患者的临床资料,所有病例均行右胸入路手术. 记录各组淋巴结的清扫及转移情况,并分析淋巴结转移的影响因素.结果 72例患者中,有48例出现淋巴结转移,淋巴结转移率为66.7％;清扫淋巴结总数为1495枚,转移181枚,淋巴结转移度为12.1％,平均每例清扫淋巴结20.8枚.在各组淋巴结中,右喉返神经旁（1R组）淋巴结转移率最高,达30.6％（22/72）.左喉返神经旁淋巴结（2L组、4L组和5组） 转移率为12.5％（9/72）.淋巴结转移率与肿瘤大小和浸润深度有关（均P＜0.05）,而与病变部位和分化程度无关（P＞0.05）.结论 胸段食管癌淋巴结转移以右喉返神经旁淋巴结转移为主,故其手术最佳入路应是右胸入路,淋巴结清扫则应以右、左喉返神经旁淋巴结为重点的系统纵隔、腹野淋巴结清扫.     

Appropriate lymph node dissection for early gastric cancer based on lymph node metastases

BACKGROUND: Lymph node dissection in patients with early gastric cancer is controversial because lymph node metastases are much less common than in advanced cancer. Therefore, routine extensive lymph node dissection with wide resection of the stomach may be excessive, and an appropriate lymph node dissection procedure in patients with early gastric cancer should be established. METHODS: Retrospectively, 588 consecutive patients with early gastric cancer were analyzed by univariate and multivariate analysis to predict lymph node metastases with clinicopathologic variables. The sites and rates of lymph node metastases for each tumor location were mapped. RESULTS: In early gastric cancer, depth of invasion was an independent predictive factor of lymph node metastases. In cancer confined to the mucosa, however, tumor diameter was the only predictive factor. In contrast, tumor diameter, macroscopic appearance, and histologic type were not predictive factors in early gastric cancers invading the submucosa. In mucosal cancer, metastasis to lymph nodes was confined to the paragastric lymph nodes on the same side of the stomach as the tumor. In submucosal cancer, the incidence of lymph node metastasis was 2% to 17% in group 1 and 1% to 3% in group 2 lymph nodes. CONCLUSIONS: In mucosal cancer, lymph node dissection is unnecessary for tumors measuring less than 30 mm, and limited lymph node dissection with local gastrectomy is appropriate when tumor diameters are 30 mm or greater. In submucosal cancer, gastrectomy with dissection of group 1 and some group 2 lymph nodes should be sufficient to remove all nodal metastases.     

Studies on gastric lymphatics by using activated carbon particle (CH44) and lymph node metastasis of gastric cancer

Gastric lymphatics in 200 patients of gastric cancer were studied by injection of activated carbon particles (CH44). By observing the carbon flow intraoperatively and examining stained lymph nodes, gastric lymphatics for individual regions (cardia, lesser curvature, left greater curvature and right greater curvature) were evaluated. The cardiac orifice has a main series of lymphatics along the left gastric artery and also has other lymphatics along the splenic artery, left phrenic artery, esophagus, lesser omentum and diaphragm. The left greater curvature depends on the lymph flow along the splenic artery. The lesser curvature has a main lymphatic stream along the left gastric artery. The right greater curvature has convened lymphatics around pancreatic head. Most streams gather around celiac axis, while the flow along right gastro-epiploic vein is also important. We also studied the relationship between the site of gastric cancer and metastasis is to the lymph nodes in 1097 gastrectomized patients. They had received more than R2 lymphatic dissection successfully. In the cases with lesions located in the upper part of the stomach, n4 (positive findings of metastasis to group 4 lymph nodes) is greater than n3 (positive findings of metastasis to group 3 lymph nodes). We concluded that most of gastric lymphatics run along the proper gastric vessels and gathered around celiac axis. For lymph node dissection in gastric cancer, it is important to know the direction of the gastric lymphatics based on tumor sites.     

Most Important Lymph Node Information in Gastric Cancer: Multivariate Prognostic Study

Background: In gastric cancer, the level and number of lymph node metastases is useful for predicting survival, and there are several staging systems for lymph node metastasis. The aim of this study was to compare the several lymph node classifications and to clarify the most important lymph node information associated with prognosis using multivariate analysis.Methods: A total of 106 patients with histologically node-positive gastric cancer treated by radical gastrectomy and extended lymph node dissection (D2, D3) were studied. The level of lymph node metastasis was categorized simply as Level I nodes (perigastric, No.1–6), Level II nodes (intermediate, No.7–9), and Level III nodes (distant, No.10–16), irrespective of the tumor location. The Level II nodes included lymph nodes along the left gastric artery, common hepatic artery, and celiac trunk.Results: Overall 5-year survival rate was 51%. Univariate analysis showed that 5-year survival rate was significantly influenced by the level of positive nodes (P < .01), total number of positive nodes (P < .01), number of positive Level I nodes (P < .01), and number of positive Level II nodes (P < .01), in addition to the tumor location (P < .05), tumor size (P < .05), gross type (P < .01), and depth of wall invasion (P < .01). Of these, independent prognostic factors associated with 5-year survival rate were the number of positive Level II nodes (0–1 vs. 2) (62% vs. 19%, P < .01) and the depth of wall invasion (within vs. beyond muscularis) (79% vs. 43%, P < .01).Conclusions: Among several staging systems for lymph node metastases, the number of positive Level II nodes provided the most powerful prognostic information in patients with node-positive gastric cancer. When there were two or more metastases in the Level II nodes, prognosis was poor even after D2 or D3 gastrectomy.     

Surgical outcome in patients with gastric adenocarcinoma in the upper third of the stomach

BACKGROUND: The incidence of carcinoma in the cardiac area of the stomach has been increasing, but the appropriate surgical strategy for these tumors remains controversial. Here we attempt to clarify the debate by retrospectively evaluating surgical outcome. METHODS: A total of 191 patients were examined. Patients underwent potentially curative resection for gastric adenocarcinoma, primarily of the upper third of the stomach. Prognostic factors, patterns of lymph node metastasis, and the efficacy of lymphadenectomy were evaluated. RESULTS: Univariate and multivariate analyses revealed lymph node metastasis as a prognostic factor in gastric cancer. Old and new indices of efficacy were the highest for lymph node removal along the lesser curvature, followed by the paracardial regions and along the left gastric and pancreatic arteries. Removal of the lateroaortic lymph node on the cranial side of the left renal vein had a relatively high efficacy index. In esophageal invasion, the efficacy of lower paraesophageal and supraphrenic lymph node removal was high, although there were discrepancies between the 2 indices. CONCLUSIONS: The extent of lymphadenectomy should be tailored to tumor location. Lymphadenectomy might include the lateroaortic lymph nodes for advanced gastric cancer in the upper third of the stomach and the supradiaphragmatic and lower paraesophageal nodes for tumors extending to the esophagus. Randomized controlled trials are needed to verify these indices.