The Japanese journal of surgery

, Volume 19, Issue 3, pp 290–295 | Cite as

Difference in main lymphatic pathways from the lower esophagus and gastric cardia

  • Takashi Aikou
  • Hisaaki Shimazu
Original Articles

Abstract

Lymphatic pathways draining the lower esophago-cardiac region were studied in 17 patients with carcinoma of the lower esophagus or gastric cardia, by measuring radioisotope uptakes in the regional lymph nodes. The uptakes were most remarkable in lower mediastinal and upper gastric lymph nodes, when the radioactive colloid was injected at the lower esophagus. A lesser degree of uptakes were observed both in other mediastinal and abdominal lymph nodes. On the contrary, a high degree of uptakes were detected only in abdominal lymph nodes, when the colloid was injected at the gastric cardia. The results indicated that main lymphatic pathways originating from the lower esophagus advance both upward and downward, and that those from the gastric cardia make their way downward to upper gastric, para-celiac and para-aortic lymph nodes. The actual incidences of lymph node metastases were also studied in 108 patients with carcinoma of the lower esophagus and 93 patients with carcinoma of the gastric cardia. In the former group, very high incidences were observed in lower esophageal and upper gastric lymph nodes. In the latter group, the incidence was most remarkable in upper gastric lymph nodes and far less significant in lower mediastinal lymph nodes. The results confirmed those of the radioisotope study. The importance of dissection of para-aortic lymph nodes near the left renal vein was also stressed.

Key Words

lymphatic pathway lymphoscintigraphy lower esophagus gastric cardia 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Aikou T, Natsugoe S, Tanabe G, Baba M, Shimazu H. Lymph drainage originating from the lower esophagus and gastric cardia as measured by radioisotope uptake in the regional lymph nodes following lymphoscintigraphy. Lymphology 1987; 20: 145–151.PubMedGoogle Scholar
  2. 2.
    Sefton GK, Cooper DJ. Assessment and resection of carcinoma at the gastroesophageal junction. Surg Gynecol Obstet 1977; 144: 563–566.PubMedGoogle Scholar
  3. 3.
    Parachristou DN, Fortiner JG. Adenocarcinoma of the gastric cardia. Ann Surg 1980; 6: 58–64.Google Scholar
  4. 4.
    Tatsuda M, Ishii H, Okuda S, Ishii T. Early adenocarcinoma of the cardia. Oncology 1985; 42: 232–235.CrossRefGoogle Scholar
  5. 5.
    Mishima Y, Hirayama R. The role of lymph node surgery in gastric cancer. World J Surg 1987; 11: 406–411.PubMedCrossRefGoogle Scholar
  6. 6.
    Oringer MB, Oringer JS. Esophagectomy without thoracotomy, a dangerous operation? J Thorac Cardiovasc Surg 1983; 85: 72–80.Google Scholar
  7. 7.
    Hans US, Franz B. Cancer of the distal esophagus and cardia. Ann Surg 1986; 203: 188–194.CrossRefGoogle Scholar
  8. 8.
    Tatk C, Jarley K. Survival after surgery for advanced carcinoma of the stomach other than the cardia. Am J Surg 1982; 143: 748–750.CrossRefGoogle Scholar

Copyright information

© The Japan Surgical Society 1989

Authors and Affiliations

  • Takashi Aikou
    • 1
  • Hisaaki Shimazu
    • 1
  1. 1.The First Department of SurgeryKagoshima University School of MedicineKagoshimaJapan

Personalised recommendations