CLASSIFICATION OF LYMPH NODES THAT CAN HELP CHOOSING THE OPTIMAL EXTENT OF LYMPH NODE DISSECTION FOR GASTRIC CANCER

R.B.BAYRAMOV, R.T.ABDULLAEVA, V.J.MAHMUDOV

Azerbaijan Medical University, Baku, AZERBAIJAN

The extent of lymph node dissection for gastric carcinoma is unresolved. The aim of the study is to form classification of lymph nodes that can simplify choosing of adequate extent of lymph node dis­sec­tion in pts with gastric carcinoma. 128 pts (distal subtotal gastrectomy in 54 pts, total gastr­ectomy in 70 pts, proximal gastrectomy in 4 pts) who underwent to extended lymph node dissection were enrolled to this study. The pts were operated by our surgical team in Department of Oncology, Azerbaijan Medical University from January 2001 till December 2010. For achieving the goal we analyzed retrospectively and prospectively the rate of lymphogenic metastases to different lymph nodes in cases of gastric carcinoma of different part of the stomach. On the basis of the result of analysis we tried to determine the rule of lymphogenic metastases in cases of gastric carcinoma. According to rule of lymphogenic metastases we prefer the following classification of lymph nodes for gastric carcinoma.

1. Local lymph nodes – 1, 2, 3, 4, 5, 6 zones; 2. Regional lymph nodes – 7, 8, 9, 10, 11 zones; 3. Extraregional lymph nodes – 12, 13, 14 zones; 4. Distant lymph nodes – 15, 16, 110 zones.

Local lymph nodes are the first tie lymph nodes located on the antegrade lymphatic flow. Carcinoma cells are initially carried to these lymph nodes. Regional lymph nodes are the second tie lymph nodes lo­ca­ted on the antegrade lymphatic flow. Carcinoma cells are carried to these lymph nodes mainly from lo­cal lymph nodes. İt is notable that the 9^th zone’s lymph nodes are the last lymph nodes on the antegrade lym­phatic flow. The tumor cells continue to be divided in the lymph nodes and time by time the tumor cells’ mass gradually replaces the lymphatic tissue. By the same time the tumor cells are continuously carried from the primary focus. Subsequently anteqrade lymphatic vessels are obturated by cancer cells and retro­grade lymphatic flow develops. So, extraregional lymph nodes are the first tie lymph nodes on the retro­grade lymphatic flow. Distant lymph nodes are the last lymph nodes on the retrograde lymphatic flow. So the recommended classification allows choose the extent of surgery in pts with gastric car­ci­no­ma more adequately. In all pts with gastric carcinoma it is wise to remove all (the local and the regio­nal) lymph nodes on the antegrade lymphatic flow. If there is found multiple enlarged or conglomerated re­gi­o­nal lymph nodes (presumable sign of the development of retrograde lymphatic flow) it is reco­m­­mended to remove the lymph nodes (the extrareginal and the distant) on the retro­grade lymphatic flow.

Date: 2014-12-28; view: 997