Effects of initial disease status on lymph flow following gastrectomy in cases of carcinoma in the remnant stomach

Abstract

Purpose In cases of carcinoma in the remnant stomach (CRS), the lymphatic flow may be altered by the initial surgery. In this study of CRS after gastrectomy, we investigated how the regions of lymph node metastasis and changes in lymphatic flow depend on initial disease status. Method The study included 76 patients with CRS who underwent gastrectomy between September 2002 and November 2014. We analyzed and compared the clinicopathological factors and survival periods between patients after distal gastrectomy for malignant disease (group M, 33 patients) and patients after distal gastrectomy for benign disease (group B, 43 patients).Results The depth of tumor invasion was more advanced in group B (T1/T2/T3/T4: group M 18/1/7/7, group B 8/11/ 8/16; P = 0.002). However, the degree of lymph node metastasis did not differ significantly between the two groups. The incidence of lymph node metastasis was high at stations 2 (19 %), 4sa (17 %), 10 (25 %), 11p (19 %), and 11d (27 %) in group M and 1 (14 %), 3 (23 %), and 4sb (15 %), and the mesojejunal lymph node (21 %) in group B. Lymph node dissection was highly beneficial at station 3, station 7, and the mesojejunum in both groups, but not at stations 10 or 11d.Conclusion As compared with group B, group M showed higher incidences of lymph node metastasis in the greater curvature, splenic hilum, and lymph nodes along the splenic artery, suggesting the predominance of lymphatic flows from the greater curvature to the splenic hilum and from the remnant stomach to the splenic artery.

Evaluation of Optimal Lymph Node Dissection in Remnant Gastric Cancer Based on Initial Distal Gastrectomy

“…In the present study, operation interval from initial gastrectomy to surgery for RGC was significantly shorter in group M than in group B, which is consistent with that observed in previous studies (17,18). Although operation time was longer, the number of dissected LNs was significantly lower in group M, which was considered to be related to LN dissection of primary gastrectomy.…”

Different risks of nodal metastasis by tumor location in remnant gastric cancer after curative gastrectomy for gastric cancer

“…However, several studies have also shown that NG tumors have a very low potential to metastasize to the nodes along the G [12,14]. Such a metastatic tendency is expected to be preserved even in RGC at the NG, in which all lymphatic flow from the remnant stomach goes to the G [2]. The present study clearly demonstrated that the independent risk factors for nodal metastasis in the RGC were the tumor location, size and depth.…”

“…RGC is mostly limited to the upper third of the stomach. As the nodal station of the lesser curvature side is completely dissected at the primary surgery, all lymphatic flow from the remnant stomach reportedly travels to the greater curvature (G), regardless of the location [2]. Therefore, total gastrectomy with splenectomy is recommended for RGC [3].…”

“…A JCOG0110 phase III study targeting primary GC not invading the G clearly showed that metastatic rate to the nodes along the splenic artery or the splenic hilar nodes was very low [9]. In contrast, RGC located at the NG has shown a lymphatic flow to the G side [2]. However, whether or not these tumors show nodal metastasis equally to the RGC located at the G is unclear at present.…”

Is subtotal gastrectomy feasible for the treatment of gastric stump cancer located at the anastomotic site after distal gastrectomy for benign lesions?

“…The lymphatic pathway in GSCs differs from that in the original stomach. In addition to the left gastric artery and posterior gastric artery in the normal stomach, an important lymphatic flow pathway exists along the anastomotic site and jejunum [30]. During the TG and SG procedures, the lymph nodes in the anastomotic jejunal mesentery or the duodenum were also removed.…”