The guide of the regularity of lymph node metastasis to the extent of resection for proximal advanced gastric cancer

Objective To investigate the regularity of lymph node metastasis in proximal advanced gastric cancer,in order to guide the extent of stomach resection(proximal or total gastrectomy) and the resection of spleen or splenic preservation.Methods The clinicopothological data of 87 patients with proximal advanced gastric cancer who underwent radical gastrectomy in our hospital from January 1989 to October 2010 were retrospectively analyzed.The number and size of detected lymph nodes were recorded.The sum and the average number of detected lymph nodes,the total rate of lymph node metastasis and the metastasis rates of No.1-16 lymph nodes were calculated.Results A total of 4 828(30 to 157) lymph nodes were detected form the surgical specimens of 87 patients with proximal advanced gastric cancer,and the average number of detected lymph nodes was 55.49 ± 20.19.Among 4 828 lymph nodes,there were 3 881 nodes ≤5mm,accounting for 80.39%.71 of 87 cases with lymph node metastasis,the total rate of lymph node metastasis was 81.61%;Among 918 lymph nodes with metastasis,there were 562 nodes ≤5 mm,accounting for 61.22%.The metastasis rates of No.1-4 and No.7-9 lymph nodes were higher(40.22% to 79.31%),the metastasis rates of No.12-15 lymph nodes were lower(0 to 2.30%),and the metastasis rate of No.16 lymph node was 14.94%.The metastasis rates of No.5 and No.6 lymph nodes were 21.84% and 14.94%,respectively.The metastasis rates of No.10 and No.11 lymph nodes were 34.48% and 19.54%,respectively.Conclusions The metastasis of lymph node in proximal advanced gastric cancer has certain regularity,which can provide a significant guidance for lymphadenectomy.Total gastrectomy plus splenectomy is a feasible radical surgery for proximal advanced gastric cancer,because of the requirement of lymphadenectomy for No.5-6 and No.10-11 lymph nodes.