Abstract
We studied the main gastric lymphatics from the stomach to the abdominal para-aortic lymph nodes (No.16) by means of direct injection of the activated carbon particle (CH44) into the regional lymph nodes during surgery in 35 patients, and endoscopic injection of the CH44 into the gastric submucosal layer around the cancer lesion before surgery in 102 patients. We found 2 main lymphatic routes, subdivided into 3 routes as follows; (1) Left side routes were via the celiac artery, the splenic artery, and the left subphrenic artery, and (2) Right side routes were via the mesenteric vessels, the celiac artery, and retropancreatic route. The percentages of black stained No.16 nodes were high in “lateral a2” nodes of cardiac cancer (56.5%) and in “inter b1” nodes of antral cancer (60.0%). We also studied the frequency and prognosis associated with No.16 lymph node metastases in gastric cancer in 312 patients referred for surgical treatment between 1974 and 1988. The No.16 node metastatic rate was 25% (78/312), and it was high in lateral a, bl and inter bl nodes of cardiac cancers, and in inter bl and lateral bl nodes of antral cancers. No.16 nodes should be dissected for N3, or S2 and N2, or S3 cases except for absolute non-curative cases. The 5-year survival rate for P (-) and H (-) patients who underwent relative non-curative resection was 23.1%, and that for patients with one or two positive No.16 nodes was 23.3%, suggesting that dissection of No.16 nodes was significant for these cases.
