Lymph node metastasis from carcinoma of the distal one-third of the stomach

Abstract

BACKGROUND: A detailed and thorough pathoanatomic study of lymph node (LN) metastases of adenocarcinoma of the distal one-third of the stomach is lacking. METHODS: From December 1987 to March 1992, 190 patients who underwent radical gastrectomy was analyzed. All LN were dissected and labeled according to the Japanese General Rules for the Gastric Cancer Study. RESULTS: A total of 7052 LN with average of 37.1 per specimen were removed. LN metastases were encountered in 121 patients (63.7%). The most frequent LN metastases were perigastric, above common hepatic artery, along left gastric artery, and hepatoduodenal ligament. The incidence of LN metastasis varied and was highest when tumor was located close to either curvature and extended to duodenum or midbody. The high incidence of LN metastases in the hepatoduodenal ligament was a unique pathologic feature of lower stomach cancer (P = 0.0012). Univariate and multivariate analysis revealed that depth of cancer invasion was the only factor related to LN metastases. CONCLUSIONS: Cancer in the distal one-third of the stomach had a high incidence of LN metastasis to hepatoduodenal ligament nodes (No. 12). The LN metastasis is correlated with depth of cancer invasion.