Gastric cancer: Patterns of disease spread via the perigastric ligaments shown by CT

The stomach is suspended in the abdominal cavity by perigastric ligaments, which are derived from the dorsal and ventral mesogastrium. These ligaments provide a direct contiguous pathway for the peritoneal spread of gastric cancer. In this article, we discuss the embryology and anatomy of the stomach and describe the specific ligamentous routes along which gastric cancers may spread by direct invasion.

Extragastric disease alters the prognosis and treatment options available to patients with gastric cancer. Familiarity with the stomach's embryology will help the radiologist understand its anatomy and, therefore, the patterns of regional spread of gastric cancer. The location of the primary tumor can predict involvement of specific perigastric ligaments because locoregional spread of gastric cancer occurs along the arteries, veins, nerves, and lymphatic channels within those ligaments. Thus, identifying the location of the primary tumor can potentially improve patient outcomes.