Typical and non-typical lymphogenic spread of gastric cancer (author s transl)

Abstract:  Incidence and distribution of lymph node metastases were examined in 100 gastrectomy specimens with 104 primary gastric carcinomas. Special emphasis was placed on the correlation with the location of the tumor and its size as well as the depth of infiltration and the tumor histology. Sixty-one percent of carcinomas with a diameter of up to 6 cm had lymph node metastases while this was the case in 83% of larger tumors. Infiltration of the muscularis propria only was associated with a 23% incidence of lymphogeneous metastases. This figure rose to 75% if the tumor reached the subserosa. Carcinomas of the diffuse (Lauren) or infiltrating (Ming) type show metastases more frequently (83% and 81% respectively) than those of the intestinal or expansive type (58%). In addition, several regions of lymphatic drainage are more frequently involved with the diffuse type. In only 2 patients (2% of all patients or 3% of the patients with lymphogeneous metastases) skipping of lymph nodes could be observed. In all other patients distant lymph nodes showed metastases only if the perigastric nodes next to the tumor were involved also. These findings support a differentiated, stage- and histology-dependent surgery.