6 Gastric Cancer

The medial (right) border of the stomach is termed the lesser curvature, and the lateral (left) border, the greater curvature. The anterior and pos­ terior surfaces of the stomach have vascular supply and lymphatic drainage related to the nearer of the curvatures, although there is considerable crossover. The stomach is covered by peritoneum with the ex­ ception of the gastrophrenic peritoneal reflection, a small space posterior to the cardia. The arterial blood supply is from the celiac trunk, which gives rise to the left gastric artery, supplying the cardia and then turning caudally to supply the lesser curvature. The splenic artery arises from the celiac trunk and is partially embedded in the pan­ creas before reaching the splenic hilum. The short gastric artery and the left gastroepiploic artery arise from the splenic artery to supply the greater curva­ ture. Finally, the common hepatic artery arises from the celiac trunk, then branches into the proper he­ patic artery and the gastroduodenal artery. The for­ mer gives off the right gastric artery, supplying the pyloric area and anastomosing with the left gastric artery; the latter divides into the right gastroepi­ ploic and anterior superior pancreatiduodenal ar­ teries. The right gastroepiploic artery supplies the inferior portion of the greater curvature and anasto­ moses with the left gastroepiploic branches. The venous drainage of the stomach corresponds to the arterial system. The left gastric vein arises from the lesser curvature, following a course with the left gastric artery to reach the portal vein. The right gastric vein also reaches the portal vein, hav­ ing been formed from venous drainage from the py­ loric area. Right and left gastroepiploic veins arise from the areas supplied by the corresponding arter­ ies; the right vein ends in the superior mesenteric vein after having joined the gastrocolic vein, while the left vein ends in the splenic vein. Short gastric veins drain the fundus and the upper portion of the greater curvature and drain into the splenic vein. The lymphatic drainage follows a similar course: drainage from the lesser curvature forms a conflu­ ence in left gastric nodes, and in conjunction with paracardial nodes drainage the cardia, drains into