Lymphatic drainage of the stomach

Lymphatic drainage of the stomach

Understanding the lymphatic drainage of the stomach is the key to understanding radical surgery for gastric cancer. The lymphatics of the antrum drain into the right gastric lymph node superiorly and right gastroepiploic and subpyloric lymph nodes inferiorly . The lymphatics of the pylorus drain to the right gastric suprapyloric nodes superiorly and the subpyloric lymph nodes situated around the gastroduodenal artery infe riorly . The e ff erent lymphatics from suprapyloric lymph nodes converge on the para-aortic nodes around the coeliac axis, whereas the e ff erent lymphatics from the subpyloric lymph nodes pass to the main superior mesenteric lymph nodes situated around the origin of the superior mesenteric arter The lymphatic vessels related to the cardia communicate freely with those of the oesophagus. The prognosis of operable cases of carcinoma of the stomach depends on whether or not there is histological evidence of regional lymph node involvement. Retrograde (downwards) spread may occur if the upper lymphatics are blocked. In Japan, lymph node dissection is highly advanced and the Japanese Research Society for Gastric Cancer has assigned a number to each lymph node station to aid pathological staging ( Figure 67.29 ). Friedrich Ernest Krukenberg , 1870–1946, ophthalmologist, Halle, Germany , wrote a classic paper on malignant tumours of the ovary in 1896. Sister Mary Joseph (Julia Dempsey) , 1856–1939, Nursing Superintendent, St Mary’s Hospital, Rochester, MN, USA, noted the presence of umbilical nodules in many patients with adv anced gastric cancer. She drew this to the attention of Dr William Mayo, founder of the Mayo Clinic. Patients with incurable disease should not subjected to futile - radical surgery , hence the value of preoperative CT/PET and laparoscopic staging. Haematogenous metastases, involvement of the distant peritoneum, M1 nodal disease and fixation to structures that are not resectable are unequivocal features of incurable disease. Involvement of another organ per se does not imply incurability , provided it can be excised.

(a) 18 2 10 1 11 9 12 8 13 16 5 3 4 6 4 Figure 67.29 Lymphatic drainage of the stomach and nodal stations by the Japanese classi /f_i cation: posterior view.