Clinical And Experimental Investigate On Lymph Flow And Metastasis For Gastric Cardia Cancer

Objective: To investigate the role of lymphatic metastasis in gastric cardia cancer and the rational extent of lymph nodes dissection.Methods: Clinicopathological data of 77 patients with gastric cardia cancer from June, 1999 to Dec, 2004 were reviewed, the relationship between extent of lymph node dissection and prognosis was analyzed retrospectively, while lymph cells in vivo marked with CH44,Brdu were utilized to investigate the lymph afflux for gastric cardia cancer.Results: (1) Clinicopathological stagingâ…¢andâ…£is the major part of 77 cases of gastric cancer in the research, total 57 cases(74.0%), the ratio of lymphatic metastasis retrieved: 64.9% for N₁, 14.3% for N₂, 10.4% for N₃. (2) Negative result in detection for lymphatic metastasis in T₁ stage and tumors that maximum diameter is less than 2.0cm. The lymphatic metastasis ratios were 20% for T₂, 68.2% for T₃ and 80.8% for T₄ respectively. (3) Lymph node No.1,3,2 were often involved in the metastasis of lymph node Group 1, and lymph node No.7,8,10,9 in Group 2. In lymph node Group 3, the metastasis ratios were 6.5% for No.5, 1.3% for No.6, 1.3% for No.16, 2.6% for No.107-110. (4) The five-year survival rates were 22.7% for D₁, 31.3% for D₂,36.5% for D₃ lymphadenectomy respectively. The survival rates of patients undergone D₂,D₃ lymphadenectomy were significantly higher than that of D1 dissection (P<0.05). (5) The result of investigation for lymph flow using lymph cells in vivo marked with CH44,Brdu indicate the pathway of left gastric artery, posterior gastric artery, splenic artery, short gastric artery and left inferior phrenic artery would be the major pathway for lymph flow of gastric cardia cancer, and the superior pathway towards mediastinum is another considerable drainage direction. Conclusion The investigation using lymph cells in vivo marked with CH44,Brdu for lymph flow indicates the inner relationship between lymphatic metastasis of gastric cardia cancer and inferior and superior lymph flow system. It also suggests that D₂ or more than D₂ lymphadenec- tomy is able to achieve surgical resectability and improve the survival rate for gastric cardia cancer patients.