[Experimental study for lymphatic routes of the cardia and diaphragm]

We report discovery of the lymphatic routes in the gastric cardia and adjacent diaphragm after producing a blockage in the descending lymphatic route in dogs. CH40 black carbon hydrate was injected into the cardia portion during operation followed by total gastric and diaphragm combined resection to investigate lymphatic routes. In the 12 dogs with a blockage, and an ascending route to the lower mediastinum was recognized in 4 cases, and lateral routes from the hiatus of the esophagus to the diaphragm in a further 3 of the 12 cases. The lateral route was considered to be a collateral lymphatic route of neo-lymphatic vessel. Further, we found that phrenic lymphatic flows went in multiple directions, whereas the lymphatic flow at the phrenic lumbar vertebrae went mainly in the direction of the esophageal opening or aortic opening, although there was some expansion to the mediastinal side or celiac side. Consequently, it was assumed that metastasis to the lateral direction besides the ascending route might occur in cases with cancer in the cardiac portion infiltrating to the hiatus of the esophagus.