Tokunaga Masanori, Ohyama Shigekazu, Hiki Naoki, Fukunaga Tetsu, Yamada Kazuhiko, Sano Takeshi, Yamaguchi Toshiharu
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
World J Surg. 2009 Jun;33(6):1235-9. doi: 10.1007/s00268-009-9985-6.
Understanding the lymphatic drainage route in gastric cancer is crucial for complete lymph node retrieval from sites susceptible to metastasis. However, the lymphatic stream of the stomach is complex and remains incompletely characterized.
Patients with small (<4 cm) serosa-negative gastric cancer with solitary lymph node metastasis treated at the Cancer Institute Hospital were included in this study. A total of 135 patients were classified according to the location of the solitary lymph node metastasis into the left gastric artery (LGA) group, the right gastroepiploic artery (RGEA) group, the right gastric artery (RGA) group, or the splenic artery (SA) group. The location of the primary tumors was investigated to aid the mapping of the lymphatic stream of the stomach.
Lymphatic flow in LGA (65 patients) and in RGEA (57 patients) are main lymphatic drainage routes of the stomach. The lymphatic area overlapped in the lower third of the stomach in LGA and RGEA, and the lymphatic flow associated with gastric cancer located within this overlapped area can be multidirectional. Skip metastases were observed in 13 patients (10%), and all skip metastases were observed in the suprapancreatic area (station 7, 8a, 9, or 11p).
The lymphatic stream of the stomach is complicated and multidirectional. Understanding and mapping the complex lymphatic streams of the stomach will allow surgeons to perform more effective lymph node dissection during gastric cancer surgery.
了解胃癌的淋巴引流途径对于从易发生转移的部位完整切除淋巴结至关重要。然而，胃的淋巴引流较为复杂，其特征仍不完全明确。
本研究纳入了在癌症研究所医院接受治疗的小（<4 cm）浆膜阴性胃癌伴孤立性淋巴结转移的患者。根据孤立性淋巴结转移的位置，将135例患者分为胃左动脉（LGA）组、胃网膜右动脉（RGEA）组、胃右动脉（RGA）组或脾动脉（SA）组。对原发肿瘤的位置进行研究，以辅助绘制胃的淋巴引流图。
LGA组（65例患者）和RGEA组（57例患者）的淋巴引流是胃的主要淋巴引流途径。LGA组和RGEA组在胃下三分之一处的淋巴区域重叠，位于该重叠区域内的与胃癌相关的淋巴引流可能是多方向的。13例患者（10%）观察到跳跃转移，所有跳跃转移均出现在胰上区（第7、8a、9或11p站）。
胃的淋巴引流复杂且多方向。了解并绘制胃复杂的淋巴引流图将使外科医生在胃癌手术中能够更有效地进行淋巴结清扫。
