Clinical significance of lymphatic flows around pylorus identified by sentinel node mapping in patients with gastric cancer.

12 Background: The sentinel node (SN) concept is safely applied and validated in early gastric cancer. Gastric lymph nodes are divided into five basins with the main gastric arteries. The suprapyloric lymph nodes (No. 5) and the anterosuperior lymph nodes with the common hepatic artery (No. 8a) are classified in the right gastric artery (r-GA) basin, and the subpyloric lymph nodes (No. 6) are classified in the right gastroepiploic artery (r-GEA) basin. The aim of this study is to analyze the lymphatic flows between these lymph nodes and basins. Methods: Five hundred and fourty-nine patients with cT1N0 or cT2N0 gastric cancer underwent SN mapping. We used technetium-99 tin colloid solution and blue dye as a tracer. Results: We detected SN No. 5 in 36 (6.6 %) patients. In these patients, we detected SN No. 5 with SNs that belonged to the left gastric artery (l-GA) basin (69 %), r-GA basin (14 %), and r-GEA basin (44 %). No. 6 was detected as SN significantly more frequently with SN No. 5. We detected SN No. 6 in 100 (18.2 %) patients. In these patients, we detected SN No. 6 with SNs that belonged to the l-GA basin (42 %), left gastroepiploic artery (l-GEA) basin (4 %), r-GA basin (28 %), and r-GEA basin (41 %). No. 4d, No. 5 and No. 8a were detected as SNs significantly more frequently with SN No. 6. We detected SN No. 8a in 43 (7.8 %) patients. In these patients, we detected SN No. 8a with SNs that belonged to the l-GA basin (65 %), l-GEA basin (7 %), r-GA basin (21 %), r-GEA basin (58 %), and posterior gastric artery (p-GA) basin (7 %). No. 6 and No. 9 were detected as SNs significantly more frequently with SN No. 8a. SN No. 5 and No. 8a were tend to be detected with not SNs that belonged to the r-GA basin but No. 6, and SN No. 6 was detected significantly more frequently with No. 4d, No. 5 and No. 8a. Conclusions: Our findings show that lymphatic flows exist not only between lymph nodes which are belonged to the same basin, but also between No. 5 and No.6, and No.6 and No. 8a. On the other hand, the lymphatic flows between No. 5 and No. 8a seem to be limited. Our results suggest that the lymph node dissection of No. 6 given lymphatic flows from lesser curvature side and retroperitoneal side is important for surgery of gastric cancer.

Download Full-text

Left Gastric Artery Lymph Nodes Should Be Included in D1 Lymph Node Dissection in Gastric Cancer

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-017-3539-2 ◽

2017 ◽

Vol 21 (10) ◽

pp. 1563-1570 ◽

Cited By ~ 5

Author(s):

Naruhiko Ikoma ◽

Mariela Blum ◽

Jeannelyn S. Estrella ◽

Xuemei Wang ◽

Keith F. Fournier ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Dissection ◽

Left Gastric Artery ◽

Node Dissection ◽

Gastric Artery

Download Full-text

Left Gastric Artery Lymph Nodes Should be Included in D1 Lymph Node Dissection in Gastric Cancer

Gastroenterology ◽

10.1016/s0016-5085(17)34297-x ◽

2017 ◽

Vol 152 (5) ◽

pp. S1287-S1288 ◽

Cited By ~ 1

Author(s):

Naruhiko Ikoma ◽

Mariela Blum ◽

Jeannelyn Estrella ◽

Keith Fournier ◽

Paul Mansfield ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Dissection ◽

Left Gastric Artery ◽

Node Dissection ◽

Gastric Artery

Download Full-text

Is splenectomy for dissecting splenic hilar lymph nodes justified in scirrhous type of gastric cancer?

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.359 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 359-359

Author(s):

Tsutomu Hayashi ◽

Takaki Yoshikawa ◽

Ayako Kamiya ◽

Keichi Date ◽

Takeyuki Wada ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Survival Benefit ◽

Splenic Artery ◽

Cancer Center ◽

High Morbidity ◽

Gastric Artery ◽

Regional Lymph Nodes ◽

Metastatic Rate ◽

The Right

359 Background: Splenectomy for dissecting splenic hilar nodes (#10) should be avoided for most gastric cancer considering high morbidity and no survival benefit, while that is often selected in scirrhous type of gastric cancer because this special type frequently invades the whole stomach and the #10 nodes. Splenectomy is necessary for dissecting #10, however, survival benefit of dissecting #10 is unclear. Methods: Patients who had scirrhous gastric cancer and underwent D2 total gastrectomy with splenectomy in National Cancer Center Hospital, Japan, between 2000 to 2011 were retrospectively analyzed. The therapeutic value index was calculated by multiplying the metastatic rate of each nodal station and the 5-year survival of patients who had metastasis to each node. Results: In total, 144 patients were eligible for the present study. The most frequent metastatic site was the nodes along the lessar curvature (#3, 57%), followed by the nodes along the right gastro-epiploic artery (#4d, 45%), the right nodes located at the cardia (#1, 34%), the nodes along the left gastro-epiploic artery (#4sb, 23%), the inferior nodes at the pyloric ring (#6, 22%), the nodes along the left gastric artery (#7, 21%), the nodes along the short gastric artery (#4sa, 18%), the nodes along the cardiac branched artery (#2, 15%), the nodes around the spleen (#10, 15%), the distal nodes along the splenic artery (#11d, 15%), the proximal nodes along the splenic artery (#11p, 13%), the nodes around the celiac artery (#9, 13%), and the nodes along the common hepatic artery (#8a, 10%). These lymph nodes had a metastatic rate of more than 10%. The node with the highest index was #3(18), followed by #4d(13.4), #1(9.59), #4sa(5.85), #4sb(5.75), #10(4.86), #7(4.16), #11d(4.16), #11p(3.87), #2(3.07), #8a(2.08), and #9(1.39). The index of #10 was exceeded that of #2, #7, #8a, and #9 which are the key nodes dissected in D2. Conclusions: The metastatic rate of splenic hilar nodes was relatively high, and the therapeutic index was the sixth highest in the fifteen regional lymph nodes included in D2 dissection. Splenectomy for dissecting splenic hilar nodes would be justified in scirrhous type of gastric cancer considering its survival benefit.

Download Full-text

Sentinel node biopsy using blue dye and technetium99 in advanced gastric cancer: anatomical drainage and clinical application

Brazilian Journal of Medical and Biological Research ◽

10.1590/1414-431x20165341 ◽

2016 ◽

Vol 49 (8) ◽

Author(s):

F.A.V. Santos ◽

A.P. Drummond-Lage ◽

M.A. Rodrigues ◽

M.A. Cabral ◽

M.S. Pedrosa ◽

...

Keyword(s):

Gastric Cancer ◽

Sentinel Node ◽

Advanced Gastric Cancer ◽

Sentinel Node Biopsy ◽

Clinical Application ◽

Blue Dye ◽

Node Biopsy

Download Full-text

Laparoscopic infrapyloric lymph nodes dissection through the right bursa omentalis approach for gastric cancer

BMC Surgery ◽

10.1186/s12893-021-01192-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kun Yang ◽

Wei-Han Zhang ◽

Kai Liu ◽

Xin-Zu Chen ◽

Xiao-Long Chen ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Laparoscopic Gastrectomy ◽

Operation Time ◽

D2 Lymphadenectomy ◽

Estimated Blood Loss ◽

Bursa Omentalis ◽

The Mean ◽

Infrapyloric Lymph Nodes ◽

The Right

Abstract Background A complete dissection of infrapyloric lymph nodes is the key to a curative gastrectomy, which can be sometimes technically challenging in laparoscopic surgery. Methods One hundred and eighteen patients with gastric cancer undergoing laparoscopic gastrectomy with D2 lymphadenectomy in which the infrapyloric lymph nodes were dissected through the right bursa omentalis approach were included. The clinicopathologic characteristics and surgical outcomes were analyzed retrospectively. Results The laparoscopic gastrectomy with D2 lymphadenectomy was successful in all 118 patients with no open conversion. The mean operation time was 246.6 ± 45.7 min. The mean estimated blood loss was 87.0 ± 35.9 mL. Postoperative complications occurred in 17.8% of the patients, which were treated successfully with conservative therapy or aspiration in all. There were no No.6 lymphadenectomy-associated complications, such as injury of transverse colon, vessels of mesocolon, pancreas or duodenum, no pancreatitis, pancreatic leakage or postoperative hemorrhage. The mean postoperative hospital stay was 9.6 ± 3.7 days. On average, the total lymph nodes harvested were 36.8 ± 12.9, in which the ones from the infrapyloric area were 5.1 ± 3.1. Conclusion Laparoscopic dissection of infrapyloric lymph nodes through the right bursa omentalis approach seems to be feasible and safe, facilitating a more complete No.6 lymphadenectomy for gastric cancer.

Download Full-text