| Distal gastric cancer (DGC) gastric cancer is the highest incidence of malignant lesions D2 and D3 surgical procedure is the treatment of distal gastric cancer the primary way. Lymph node metastasis of gastric cancer is an important biological characteristics, Preoperative and intraoperative pathological findings decision surgery is an important criteria. Distal gastric cancer gastric cancer is the highest incidence of malignant lesions lymph node metastasis compared to the regional lymph node metastasis both its universality also has its special laws Clinical studies have meaning and value. Further understanding of the distribution of distal gastric cancer with lymph node status, the right to choose surgery is great significance. Therefore, a clear distal gastric cancer metastasis-specific law is implemented distal gastric cancer in the reference, surgery can completely remove metastatic lymph nodes, the prognosis of patients with the decision of the main factors. In this paper, in recent years, I treated Branch distal gastric cancer patients in 42 cases, right distal gastric cancer lymph node metastasis research, want to distal gastric cancer surgery and indications for the surgery grasp the reasonable choice for a certain reference.1. Research MethodsThis article from September 2005 to December 2006 Jilin University during the Sino-Japanese Friendship Hospital gastrointestinal surgery, the 43 treated cases of distal gastric cancer patients, the patients were more facilities D2 radical mastectomy. Surgical method : removal of lymph nodes around the stomach to D (dissection), N1, N2, N3 said regional lymph nodes around the stomach of other stations. Second leg to remove lymph nodes as D2, the third leg to remove lymph nodes as D3. Limitations of gastric cancer has not violated serosa to serosa or reactive, stomach no lymph node metastasis in patients with D2 surgery. Limitations of gastric cancer has violated serosa, is a prominent nodules serosa-D2 or D3. N2 positive when conditions allow, to choose D3. Anastomosis : distal gastrectomy colon ago, the proximal half of the small bend-mouth Billroth II gastrojejunostomy anastomosis. Total gastrectomy : Esophageal jejunal Roux-en-Y P-jejunum gastrectomy. Clinical and pathological data in accordance with the 1987 International League announced UICC-TNM phased standards, All patients underwent endoscopy and biopsy diagnosis of postoperative pathologic examination of the distal gastric cancer. Gastric cancer resection of primary tumor and lymph nodes were detected by 10% neutral formalin-fixed, producers, HE staining of slides, Pathological examination system.2. Statistical AnalysisThe data were processed, adopted X2 test,P <0.05 considered statistically significant.3. The result of analysis on the lymph node metastasis in DGC1.Distal gastric cancer metastasis Overview : 43 patients with gastric cancer, 27 patients with lymph node metastasis, transfer rate of 67.4%. Early gastric cancer metastasis rate of 12.5%, of the progress of gastric cancer metastasis rate of 77.8%. All of the group of lymph node metastasis Case No. 3,6 highest, followed by the first 4,5,7,8,9,1,11,12,10,14,15.2. depth of tumor invasion and metastasis : gastric tumor invasion by the level submucosa-13, only 1 in 3 groups of lymph node metastasis. Myometrial six cases, only 3,5,12,14,15 group lymph node metastasis. Abused to the serosal layer 19 to 3,4,6,7,8,9 group of lymph node metastasis in patients with the greatest number of cases. The tumor cavity near the structure or expansion of 4 cases, the groups have lymph node metastasis, 3,5 groups of lymph node metastasis in patients with the greatest number of cases. T2 and T3 compared with T2 T4 group, T3 and T4 group, the same group of lymph node metastasis rate differences with statistical significance (p <0.05).3. The diameter of the tumor and lymph node metastasis in the group The situation : by tumor diameter divided into three groups : group 1 d<5cm, Group 2 : 5cm10cm. Group 1 in 27 cases, in section 3,4,5,the group of lymph node metastasis in patients with the greatest number of cases. 7,8,9, 10,14,15 second paragraph, the second group of 15 cases, the groups of lymph node metastasis may occur, 4,6,3,5,7,8,9,1,particularly in the first group of lymph node metastasis in patients with the most number of cases. Group 3 1 cases, the groups of lymph node metastasis occurred.4. Advanced gastric cancer Borman different type of the group with lymph node metastasis : Borman distal gastric cancer patients III largest share. Remote progress in 27 cases of gastric cancer were found in patients with type 1 Bormann. Bormann type 2 patients 2, Group 3 lymph node metastasis in 1. Borman III in 21 patients, the group of lymph nodes may be transferred. In Group 6 incidence of lymph node metastasis in patients with the most remaining 3,4, 5, Section 7,8,9 of lymph node metastasis in patients with the most number of cases. Borman patients with type IV 3, 4 and 6 Group lymph node metastasis in patients with the most number of cases. Advanced gastric cancer gross type, and of limited-Borrman Borrman I and II, the Growth is invasive tendencies Borrman III and IV Borrman poorly differentiated, most of poorly differentiated adenocarcinoma and signet ring cell carcinoma. 6. Mucinous carcinoma and adenocarcinoma of the group of lymph node metastasis : mucinous carcinoma in 5 cases, signet ring cell carcinoma in 3 cases. 3 signet ring cell carcinoma tumor infiltrating not confined to the mucosal layer depth, the depth of invasion of T2,T3,T4,and no lymph node metastases. 40 cases of patients with adenocarcinoma, the group had lymph node metastasis in 3,6,4,5, Section 7,8,9 of lymph node metastasis in patients with the most number of cases. Mucinous carcinoma and adenocarcinoma compared to the first three groups lymph node metastasis rate difference was statistically significant. Mucinous carcinoma and adenocarcinoma than in Group 6 lymph node metastasis rate difference was statistically significant (p <0.05). In summary, the distal gastric cancer metastasis and the depth of invasion, and the malignant tumor closely related; Early distal gastric cancer D2-choice proposals for expansion, only cleaning station and the first group will No.7,8,9 ; Phase Ib lymphadenectomy in patients over the scope of at least D2, No.7,8,9 group lymph node dissection must; the highly suspected or confirmed to have been No. 1 station to 2 station metastasis tumor diameter >5cm infiltration serosal layer has advanced to the distal cancer, and should, as far as possible D3. Signet ring cell carcinoma without lymph node metastasis, in section 3,6 group mucinous carcinoma lymph node metastasis rate of less than adenocarcinoma. But all the results still need to be confirmed by further study.
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