Skip to main content

Advertisement

SpringerLink
Log in

Analysis of the Lymphatic Stream to Predict Sentinel Nodes in Gastric Cancer Patients

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the pattern of lymphatic drainage in gastric cancer patients to predict sentinel node placement according to tumor location.

Methods

A total of 462 pT1 or T2 gastric adenocarcinoma patients with metastasis to 1–3 lymph nodes (LNs) who had undergone lymphadenectomy greater than D1+β were included in the study. The distribution of metastatic LNs was evaluated according to tumor longitudinal and circumferential location. The incidence rate of atypical metastasis (skip or transversal metastasis) and related clinicopathologic factors were analyzed.

Results

The rates of skip and transversal metastasis were 15.8 % (73 of 462) and 10.3 % (23 of 224), respectively. Atypical metastasis was observed regardless of tumor location. Tumors that showed the most frequent atypical metastasis were located in the lower third and lesser curvature (LC) of the stomach (29.0 % for skip metastasis and 18.0 % for transversal metastasis). In uni- and multivariate analyses, an LC tumor was a risk factor for skip metastasis, and tumor located circumferentially in the LC or longitudinally in the lower third of the stomach was an independent risk factor for transversal metastasis. There was no correlation between tumor aggressiveness and atypical metastasis.

Conclusions

Tumors at any location had a chance of atypical metastasis; however, those located longitudinally in the lower or circumferentially at the LC had a significantly higher chance of atypical metastasis compared to other locations. When sentinel node navigation surgery is applied, special care should be taken with tumors at these locations to prevent false-negative results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Matsukuma A, Furusawa M, Tomoda H, Seo Y. A clinicopathological study of asymptomatic gastric cancer. Br J Cancer. 1996;74:1647–50.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Adachi Y, Mori M, Maehara Y, Kitano S, Sugimachi K. Prognostic factors of node negative gastric carcinoma: univariate and multivariate analyses. J Am Coll Surg. 1997;184:373–7.

    CAS  PubMed  Google Scholar 

  3. Kitagawa Y, Fujii H, Mukai M, Kubota T, Otani Y, Kitajima M. Radio-guided sentinel node detection for gastric cancer. Br J Surg. 2002;89:604–8.

    Article  CAS  PubMed  Google Scholar 

  4. Hayashi H, Ochiai T, Mori M, Karube T, Suzuki T, Gunji Y, et al. Sentinel lymph node mapping for gastric cancer using a dual procedure with dye- and gamma probe-guided techniques. J Am Coll Surg. 2003;196:68–74.

    Article  PubMed  Google Scholar 

  5. Park DJ, Lee HJ, Lee HS, Kim WH, Kim HH, Lee KU, et al. Sentinel node biopsy for cT1 and cT2a gastric cancer. Eur J Surg Oncol. 2006;32:48–54.

    Article  CAS  PubMed  Google Scholar 

  6. Park do J, Kim HH, Park YS, Lee HS, Lee WW, Lee HJ, et al. Simultaneous indocyanine green and (99m)Tc-antimony sulfur colloid-guided laparoscopic sentinel basin dissection for gastric cancer. Ann Surg Oncol. 2011;18:160–5.

    Article  PubMed  Google Scholar 

  7. Ichikura T, Sugasawa H, Sakamoto N, Yaguchi Y, Tsujimoto H, Ono S. Limited gastrectomy with dissection of sentinel node stations for early gastric cancer with negative sentinel node biopsy. Ann Surg. 2009;249:942–7.

    Article  PubMed  Google Scholar 

  8. Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg. 1995;82:346–51.

    Article  CAS  PubMed  Google Scholar 

  9. Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H. Can sentinel node biopsy indicate rational extent of lymphadenectomy in gastric cancer surgery? Fundamental and new information on lymph-node dissection. Langenbecks Arch Surg. 1999;384:149–57.

    Article  CAS  PubMed  Google Scholar 

  10. Kosaka T, Ueshige N, Sugaya J, Nakano Y, Akiyama T, Tomita F, et al. Lymphatic routes of the stomach demonstrated by gastric carcinomas with solitary lymph node metastasis. Surg Today. 1999;29:695–700.

    Article  CAS  PubMed  Google Scholar 

  11. Li C, Kim S, Lai JF, Oh SJ, Hyung WJ, Choi WH, et al. Solitary lymph node metastasis in gastric cancer. J Gastrointest Surg. 2008;12:550–4.

    Article  PubMed  Google Scholar 

  12. Moenig SP, Luebke T, Baldus SE, Schroeder W, Bollschweiler E, Schneider PM, et al. Feasibility of sentinel node concept in gastric carcinoma: clinicopathological analysis of gastric cancer with solitary lymph node metastases. Anticancer Res. 2005;25(2B):1349–52.

    CAS  PubMed  Google Scholar 

  13. Lee SE, Lee JH, Ryu KW, Cho SJ, Lee JY, Kim CG, et al. Sentinel node mapping and skip metastases in patients with early gastric cancer. Ann Surg Oncol. 2009;16:603–8.

    Article  PubMed  Google Scholar 

  14. Tokunaga M, Ohyama S, Hiki N, Fukunaga T, Yamada K, Sano T, et al. Investigation of the lymphatic stream of the stomach in gastric cancer with solitary lymph node metastasis. World J Surg. 2009;33:1235–9.

    Article  PubMed  Google Scholar 

  15. Huang B, Wang Z, Sun Z, Zhao B, Xu H. A novel insight of sentinel lymph node concept based on 1–3 positive nodes in patients with pT1–2 gastric cancer. BMC Cancer. 2011;17:11–8.

    Google Scholar 

  16. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer. 1998;1:10–24.

    Article  PubMed  Google Scholar 

  17. Tajima Y, Yamazaki K, Masuda Y, Kato M, Yasuda D, Aoki T, et al. Sentinel node mapping guided by indocyanine green fluorescence imaging in gastric cancer. Ann Surg. 2009;249:58–62.

    Article  PubMed  Google Scholar 

  18. Isozaki H, Kimura T, Tanaka N, Satoh K, Matsumoto S, Ninomiya M, et al. An assessment of the feasibility of sentinel lymph node-guided surgery for gastric cancer. Gastric Cancer. 2004;7:149–53.

    Article  PubMed  Google Scholar 

  19. Miwa K, Kinami S, Taniguchi K, Fushida S, Fujimura T, Nonomura A. Mapping sentinel nodes in patients with early-stage gastric carcinoma. Br J Surg. 2003;90:178–82.

    Article  CAS  PubMed  Google Scholar 

  20. Liu CG, Lu P, Lu Y, Jin F, Xu HM, Wang SB, et al. Distribution of solitary lymph nodes in primary gastric cancer: a retrospective study and clinical implications. World J Gastroenterol. 2007;13:4776–80.

    PubMed  Google Scholar 

  21. Ichikura T, Morita D, Uchida T, Okura E, Majima T, Ogawa T, et al. Sentinel node concept in gastric carcinoma. World J Surg. 2002;26:318–22.

    Article  PubMed  Google Scholar 

  22. Kim MC, Kim HH, Jung GJ, Lee JH, Choi SR, Kang DY, et al. Lymphatic mapping and sentinel node biopsy using 99mTc tin colloid in gastric cancer. Ann Surg. 2004;239:383–7.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Bok GH, Kim YJ, Jin SY, Chun CG, Lee TH, Kim HG, et al. Endoscopic submucosal dissection with sentinel node navigation surgery for early gastric cancer. Endoscopy. 2012;44:953–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

    Hyuk-Joon Lee MD, PhD, Hyung-Ho Kim MD, PhD & Han-Kwang Yang MD, PhD

  2. Department of Surgery, Seoul National University Hospital, Seoul, Korea

    Hyuk-Joon Lee MD, PhD, Seong-Ho Kong MD, PhD & Han-Kwang Yang MD, PhD

  3. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea

    Ju-Hee Lee MD, Do Joong Park MD, PhD & Hyung-Ho Kim MD, PhD

  4. Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea

    Hye Seung Lee MD, PhD

  5. Department of Pathology, Seoul National University College of Medicine, Seoul, Korea

    Woo Ho Kim MD, PhD

  6. Cancer Research Institute, Seoul National University, Seoul, Korea

    Hyuk-Joon Lee MD, PhD, Woo Ho Kim MD, PhD & Han-Kwang Yang MD, PhD

Authors
  1. Ju-Hee Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyuk-Joon Lee MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seong-Ho Kong MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Do Joong Park MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hye Seung Lee MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Woo Ho Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hyung-Ho Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Han-Kwang Yang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hyuk-Joon Lee MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, JH., Lee, HJ., Kong, SH. et al. Analysis of the Lymphatic Stream to Predict Sentinel Nodes in Gastric Cancer Patients. Ann Surg Oncol 21, 1090–1098 (2014). https://doi.org/10.1245/s10434-013-3392-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-013-3392-9

Keywords

Search

Navigation