Adenocarcinoma of midstomach. Clinical and pathoanatomic relation to lymph node metastases.

A detailed clinical and anatomic-pathological study of lymph node (LN) metastases from adenocarcinoma of the midstomach is lacking. To such an end, we prospectively evaluated 100 patients who underwent radical gastrectomy. A total of 3,394 LNs were removed with an average of 34 per specimen (range, 10-105). Forty-seven patients (47%) had involved LNs. The most frequent LNs involved were those along the lesser curvature (38%), greater curvature (23%), left gastric artery (19%), infrapyloric (16%), above the common hepatic artery (13%), suprapyloric (11%), and right paracardia (9%). When tumors involved the upper stomach, the frequency of LN metastases along the splenic artery and in the splenic hilum was 11.8%. Tumors along the lesser curvature or on the anterior or posterior walls had splenic hilar LN metastases in 10%, whereas of tumors involving the whole circumference, 16.7% showed with metastases. Four of 33 patients (12.1%) with early cancer had LN metastasis confined to the perigastric, left gastric artery, and above the common hepatic artery. The LN metastases were closely related to the depth of cancer invasion, location, size, gross appearance, and histology of the tumor.