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|The lymph node stations in gastric cancer. |
Romeo Giuli MD, resident.
School of General and Emergency Surgery.
University of Siena. Italy.
January 2002. Review Article.
The ideal lymphadenectomy for gastric cancer should accurately stage the extent of disease and predict prognosis; in addition it should have the potential to improve survival by selectively and completely removing all metastastic lymph nodes with minimal morbidity and mortality.
The Japanese Research Society for the study of gastric cancer published a manual in 1963 standardizing LND and pathologic evaluations for GC; these guidelines recognized 16 different LN stations that surround the stomach.
These 16 nodal stations are grouped according to the location and extension of the primary tumor (N0-N4) and the extent of lymphadenectomy is classified according the level of LND ( D1-D4).
In D1 dissections only the perigastric nodes directly attached along the lesser curvature and greater curvatures of the stomach are removed (stations 1-6, N1 level):
1 Right cardia lymph nodes
2 Left cardia lymph nodes
3 Lymph nodes along the lesser curvature
4 Lymph nodes along the greater curvature
4sa: lymph nodes along the short gastric vessels
4sb: lymph nodes along the left gastroepiploic vessels
4d: lymph nodes along the right gastroepiploic vessels
5 Suprapyloric lymph nodes
6 Infrapyloric lymph nodes
An incomplete N1 dissection is labelled a D0 lymphadenectomy.
D2 dissections (N2 level) add the removal of nodes along the left gastric artery (station 7), common hepatic artery (station 8), celiac trunk (station 9), splenic hilus, and splenic artery (station 10 and 11).
D3 dissections include the dissection of lymph nodes at stations 12 through 14, along the hepatoduodenal ligament and the root of the mesentery (N3 level):
12 lymph nodes in the hepatoduodenal ligament
13 lymph nodes on the posterior surface of the head of the pancreas
14 lymph nodes at the root of the mesentery
14A lymph nodes along the superior mesenteric artery
14V lymph nodes along the superior mesenteric vein
Finally D4 resections add the stations 15 and 16 in the para-aortic and the paracolic region (N4 level) ( 1 ).
1) Hong Jin Kim, Martin S Karpeh, Murray F Brennan. Standardization of the extent of lymphadenectomy for gastric cancer: impact on survival. Advances in Surgery, volume 35 2001, 203-223.
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