Open AccessFeatures of lymphatic metastasis of proximal gastric cancer
Author(s) -
F Sh Akhmetzyanov,
Ахметзянов Фоат Шайхутдинович,
Х А Каулгуд,
Каулгуд Харшал Ашок,
D M Ruvinskiy,
Рувинский Давид Маркович,
F F Akhmetzyanova,
Ахметзянова Фарида Фоатовна
Publication year - 2017
Publication title -
kazanskij medicinskij žurnal
Language(s) - English
Resource type - Journals
eISSN - 2587-9359
pISSN - 0368-4814
DOI - 10.17750/kmj2017-674
Subject(s) - medicine , lymph , lymphatic system , left gastric artery , cancer , metastasis , stomach , splenic artery , lymph node , esophagus , pathology , radiology
Aim. To study lymphatic metastasis of proximal gastric cancer to determine the extent of surgical intervention both on the stomach wall and lymphatic pathways.
Methods. The data on lymphatic metastasis were analyzed in 185 patients with proximal gastric cancer not extending to the esophagus who underwent gastrosplenectomy with extended lymphodissection D2 in 2 surgical departments of the Republican clinical oncology center (Kazan) in 1982-2014. All patients were morphologically verified prior to surgery. 105 out of 185 patients (56.7%) had metastases to lymph nodes.
Results. In proximal gastric cancer (within IV and V angiological segments) lymph node involvement in cancer metastases occurs in all sub-segments of the lymphatic system of the stomach. There is a fairly clear pattern: involvement of lymph nodes in metastases mainly occurs in groups №3a, 3b, and 4d, along the common hepatic artery and its branches, around the celiac trunk, along the splenic artery and in splenic hilum. In case of cancer localization in segment IV metastases were observed in 46.7%, in segment V - in 66.7% and in case of involvement of both segments IV and V - in 53.3% of patients. In gastric cancer located within segments IV and V, starting with the involvement of muscular tunic, lymph nodes of perigastric groups (№3b - in 37.1%, 4d - in 11.4%) are often affected as well as parietal lymph nodes of groups 7-12.
Conclusion. In cancer located within gastric segments IV and V gastrosplenectomy with extended lymphodissection D2 should be performed to remove lymph node groups along the splenic artery and in splenic hilum.