[Studies on gastric lymphatics by using activated carbon particle (CH44) and lymph node metastasis of gastric cancer]

Gastric lymphatics in 200 patients of gastric cancer were studied by injection of activated carbon particles (CH44). By observing the carbon flow intraoperatively and examining stained lymph nodes, gastric lymphatics for individual regions (cardia, lesser curvature, left greater curvature and right greater curvature) were evaluated. The cardiac orifice has a main series of lymphatics along the left gastric artery and also has other lymphatics along the splenic artery, left phrenic artery, esophagus, lesser omentum and diaphragm. The left greater curvature depends on the lymph flow along the splenic artery. The lesser curvature has a main lymphatic stream along the left gastric artery. The right greater curvature has convened lymphatics around pancreatic head. Most streams gather around celiac axis, while the flow along right gastro-epiploic vein is also important. We also studied the relationship between the site of gastric cancer and metastasis is to the lymph nodes in 1097 gastrectomized patients. They had received more than R2 lymphatic dissection successfully. In the cases with lesions located in the upper part of the stomach, n4 (positive findings of metastasis to group 4 lymph nodes) is greater than n3 (positive findings of metastasis to group 3 lymph nodes). We concluded that most of gastric lymphatics run along the proper gastric vessels and gathered around celiac axis. For lymph node dissection in gastric cancer, it is important to know the direction of the gastric lymphatics based on tumor sites.