Distribution of Lymph Node Metastasis Including Micrometastasis in Gastric Cancer with Submucosal Invasion |
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Authors: | Hiroshi Higashi Shoji Natsugoe Sumiya Ishigami Yoshikazu Uenosono Masataka Matsumoto Akihiro Nakajo Futoshi Miyazono Shuichi Hokita Sonshin Takao Takashi Aikou |
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Institution: | (1) First Department of Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan, |
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Abstract: | 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. |
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