![]() Ronellenfitsch U, Schwarzbach M, Hofheinz R, Kienle P, Kieser M, Slanger TE, et al. Perioperative Chemotherapy Versus Surgery Alone for Resectable Gastroesophageal Cancer. doi: 10.1007/s1012-5Ĭunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJHV, Nicolson M, et al. Japanese Classification of Gastric Carcinoma: 3rd English Edition. Japanese Classification of Gastric Carcinoma. UICC TNM Classification of Malignant Tumours. A route from the left dorsal side of the cardia to #16a2 lateral nodes via #19, along the left subphrenic artery also exists (green arrows).īrierley J, Gospodarowicz M, Wittekind C. (C) Lymphatic flow around the celiac artery and the superior mesenteric artery lead to the paraaortic nodes, which are the terminal lymph nodes of gastric cancer (red arrows). Routes from #6 to the suprapancreatic nodes via the lymphatics under the pancreatic capsule are also available (indigo arrows). There are also routes from #8a to #8p (the posterior side of the common hepatic artery), and routes from #6 to the root of the superior mesenteric artery via #14v (green arrows). (B) The lymphatic flow into the root of each artery flows via suprapancreatic nodes (orange arrows) and out to the paraaortic nodes from the left and right of the celiac artery (red arrows). (A) Lymphatic flow from the gastric wall is directed to the root of each artery via nearby perigastric nodes (red arrows). The lymphatic flow of the stomach spreads from the perigastric nodes, via the suprapancreatic nodes and nodes around the celiac artery, to the para-aortic nodes, following which it enters the systemic circulation. Schematic diagram of the lymphatic system of the stomach. MDCT gastric cancer lymph node metastasis sentinel node staging.Ĭopyright © 2022 Kinami, Saito and Takamura. In this review, we discuss the importance of determining lymph node metastasis in the treatment of gastric cancer, the associated difficulties, and the need to investigate strategies that can improve the diagnosis of lymph node metastasis. Chemotherapy for advanced gastric cancer has also progressed, and conversion gastrectomy can now be performed after downstaging, even in cases previously regarded as inoperable. Notably, advancements in surgical treatment for early gastric cancer are expected to result in individualized surgical strategies with sentinel node biopsy. Sentinel node biopsy is also important for individualizing and optimizing the extent of uniform prophylactic lymph node dissection and determining whether patients are indicated for function-preserving curative gastrectomy, which is superior in preventing post-gastrectomy symptoms and maintaining dietary habits. In contrast, several groups have examined the value of sentinel node biopsy for accurately evaluating nodal metastasis in patients with early gastric cancer, reporting high sensitivity and accuracy. Based on these findings, gastrectomy with prophylactic lymph node dissection is considered the standard surgical procedure for gastric cancer. Furthermore, peripheral nodal metastases cannot be palpated intraoperatively, nodal harvesting of resected specimens remains difficult, and the number of lymph nodes detected vary greatly depending on the skill of the technician. Preoperative nodal diagnoses are mainly made using computed tomography, although the specificity of this method is low because it is mainly based on the size of the lymph node. Most nodal metastases in gastric cancer are microscopic metastases, which often occur in small-sized lymph nodes, and are thus difficult to diagnose both preoperatively and intraoperatively. However, precise detection of lymph node metastasis remains difficult. Therefore, identifying and determining the extent of lymph node metastasis is important for ensuring accurate diagnosis and appropriate surgical treatment in patients with gastric cancer. Furthermore, when its extent is limited, nodal metastasis of gastric cancer can be cured by appropriate lymph node dissection. In the case of gastric cancer, there is a regularity to the spread of lymph node metastasis, and it does not easily metastasize outside the regional nodes. The stomach exhibits abundant lymphatic flow, and metastasis to lymph nodes is common. ![]()
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