Features of lymphatic metastasis of proximal gastric cancer

Cover Page

Abstract


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.


F S Akhmetzyanov

Author for correspondence.
Akhmetzyanov@mail.ru
Kazan State Medical University; Republican Clinical Oncology Center Kazan, Russia; Kazan, Russia

Kh A Kaulgud

Akhmetzyanov@mail.ru
Kazan State Medical University; Republican Clinical Oncology Center Kazan, Russia; Kazan, Russia

D M Ruvinskiy

Akhmetzyanov@mail.ru
Republican Clinical Oncology Center Kazan, Russia

F F Akhmetzyanova

Akhmetzyanov@mail.ru
Kazan State Medical University Kazan, Russia

  • Состояние онкологической помощи населению России в 2015 году. Под ред. А.Д. Каприна, В.В. Старинского, Г.В. Петровой. М.: МНИОИ им. П.А. Герцена. 2017; 250 с.
  • Lei W., Xin Z., Chen B. et al. Total vs. proximal gastrectomy for proximal gastric cancer: A systematic review and meta-analysis. Hepatogastroenterology. 2012; 59: 633-640. doi: 10.5754/hge11834.
  • Masahide I., Abdul K., Seigo T. et al. Prognosis of patients with gastric cancer who underwent proximal gastrectomy. Int. Surg. 2012; 97 (3): 275-279. doi: 10.9738/CC150.1.
  • Ooki A., Yamashita K., Kikuchi S. et аl. Clinical significance of total gastrectomy for proximal gastric cancer. Аnticancer Res. 2008; 28 (5B): 2875-2883. PMID: 19031928.
  • Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017; 20: 1-19. doi: 10.1007/s10120-016-0622-4.
  • Jung D.H., Ahn S.H., Park D.J., Kim H.H. Proximal Gastrectomy for Gastric Cancer. J. Gastric Cancer. 2015; (2): 77-86. doi: 10.5230/jgc.2015.15.2.77.
  • Ахметзянов Ф.Ш., Каулгуд Х.А., Ахметзянова Ф.Ф. Ближайшие результаты комбинированных и расширенных операций при раке проксимального отдела желудка. Поволжский онкол. вестн. 2017; (1): 11-15.

Views

Abstract - 17

PDF (Russian) - 10


© 2017 Akhmetzyanov F.S., Kaulgud K.A., Ruvinskiy D.M., Akhmetzyanova F.F.

Creative Commons License

This work is licensed
under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.