Skip to main content
SpringerLink
Log in

Solitary Lymph Node Metastasis in Gastric Cancer

  • Published:
Journal of Gastrointestinal Surgery

Abstract

The feasibility and diagnostic reliability of sentinel node (SN) biopsy for gastric cancer are still controversial. We studied the clinicopathological features and localization of solitary lymph node metastasis (SLM) in gastric cancer to provide useful information for use of the SN concept in gastric cancer. From 2000 to 2004, 3,267 patients with gastric cancer underwent D2 radical gastrectomy. The clinicopathological features of 195 patients with histologically proven SLM and the distribution of metastasized nodes were assessed. The incidence of SLM was 6.0% in all cases. Compared with the node-negative patients, significant differences were observed in age, tumor size, depth of invasion, and surgical type. The cumulative 5-year survival rate of patients with SLM was 80.5%, which was significantly lower than 90.2% for node-negative patients (P < 0.001). Of patients with SLM, 82.6% had it in the perigastric node area (N1), and the other 17.4% patients had skip metastasis in the N2-N3 nodes. Perigastric nodes were the most common first sites of drainage from the tumor, making them the main targets of the operative SN mapping procedure. Due to the higher than expected incidence of skip metastasis in gastric cancer, D2 lymphadenectomy should be performed until the reliability of SN navigation surgery is validated in multicenter prospective clinical trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Bozzetti F, Bonfanti G, Morabito A, Bufalino R, Menotti V, Andreola S, Doci R, Gennari L. A multifactorial approach for the prognosis of patients with carcinoma of the stomach after curative resection. Surg Gynecol Obstet 1986;162:229–234.

    PubMed  CAS  Google Scholar 

  2. Ichikura T, Tomimatsu S, Okusa Y, Uefuji K, Tamakuma S. Comparison of the prognostic significance between the number of metastatic nodes and node stage based on their location in patients with gastric cancer. J Clin Oncol 1993;11:1894–1900.

    PubMed  CAS  Google Scholar 

  3. Wu CW, Hsieh MC, Lo SS, Tsay SH, Liu WY, Peng FK. Relation of number of positive lymph nodes to the prognosis of patients with primary gastric adenocarcinoma. Gut 1996;38:525–527.

    Article  PubMed  CAS  Google Scholar 

  4. Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 2006;41:929–942

    Article  PubMed  Google Scholar 

  5. Sano T, Hollowood A. Early gastric cancer: diagnosis and less invasive treatments. Scand J Surg 2006;95(4):249–255.

    PubMed  CAS  Google Scholar 

  6. Tanaka K, Tonouchi H, Kobayashi M, Konochi N, Ohmori Y, Mohri Y, Kusunoki M. Laparoscopically assisted total gastrectomy with sentinel node biopsy for early gastric cancer: preliminary results. Am Surg 2004;70(11):976–981.

    PubMed  Google Scholar 

  7. Ganpathi IS, So JBY, Ho KY. Endoscopic ultrasonograpy for gastric cancer. Surg Endosc 2006;20:559–562.

    Article  PubMed  CAS  Google Scholar 

  8. Shinohara T, Ohyama S, Yamaguchi T, Muto T, Kohno A, Kato Y, Urashima M. Clinical value of multidetector row computed tomography in detecting lymph node metastasis of early gastric cancer. Eur J Surg Oncol 2005;31:743–748.

    Article  PubMed  CAS  Google Scholar 

  9. Nieweg OE, Bartelink H. Implications of lymphatic mapping for staging and adjuvant treatment of patients with breast cancer. Eur J Cancer 2004;40:179–181.

    Article  PubMed  CAS  Google Scholar 

  10. Kretschmer L, Hilgers R, Mohrle M, Balda BR, Breuninger H, Konz B, Kunte C, Marsch WC, Neumann C, Starz H. Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphadenectomy and early excision of their nodal disease. Eur J Cancer 2004;40:212–218.

    Article  PubMed  CAS  Google Scholar 

  11. Kitagawa Y, Fujii H, Kumai K, Kubota T, Otani Y, Saikawa,Y, Yoshida M, Kubo A, Kitajima M. Recent Advances in sentinel node navigation for gastric cancer: A paradigm shift of surgical management. J Surg Oncol (Seminars) 2005;90:147–152.

    Article  Google Scholar 

  12. Japanese Gastric Cancer Association. Japanese Classification of Gastric carcinoma, 13th edn. Tokyo: Kanehara, 1999.

  13. Kaibara N, Iitsuka Y, Kimura A, Kobayashi Y, Hirooka Y, Nishidoi H. Relationship between area of serosal invasion and prognosis in patients with gastric carcinoma. Cancer 1987;60:136–139.

    Article  PubMed  CAS  Google Scholar 

  14. Maruyama K, Gunven P, Okabayashi K, Sasako M, Kinoshita T. Lymph node metastasis of gastric cancer: general pattern in 1931 patients. Ann Surg 1989;210:596–602.

    Article  PubMed  CAS  Google Scholar 

  15. Mishima Y, Hirayama R. The role of lymph node surgery in gastric cancer. World J Surg 1987;11:406–411.

    Article  PubMed  CAS  Google Scholar 

  16. Kosaka T, Ueshige N, Sugaya J, Nakano Y, Akiyama T, Tomita F, Saito H, Kita I, Takashima S. Lymphatic routes of the stomach demonstrated by gastric carcinomas with solitary lymph node metastasis. Surg Today 1999;29:695–700.

    Article  PubMed  CAS  Google Scholar 

  17. Ichikura T, Morita D, Uchida T, Okura E, Majima T, Ogawa T, Mochizuki H. Sentinel node concept in gastric carcinoma. World J Surg 2002;26:318–322.

    Article  PubMed  Google Scholar 

  18. Tsuburaya A, Noguchi Y, Yoshikawa T, Kobayashi O, Sairenji M, Motohashi H. Solitary lymph node metastasis of gastric cancer as a basis for sentinel lymph node biopsy. Hepatogastroenterology 2002;49:1449–1452.

    PubMed  Google Scholar 

  19. Arai K, Iwasaki Y, Takahashi T. Clinicopathological analysis of early gastric cancer with solitary lymph node metastasis. Br J Surg 2002;89:1435–1437.

    Article  PubMed  CAS  Google Scholar 

  20. Bilchik AJ, Saha S, Tsioulias GJ, Wood TF, Morton DL. Aberrant drainage and missed micrometastasis: the value of lymphatic mapping and focused analysis of sentinel lymph nodes in gastrointestinal neoplasms. Ann Surg Oncol 2001;8:82–85.

    Google Scholar 

  21. Gervasoni JE, Taneja C, Chung MA, Cady B. Biologic and clinical significance of lymphadenectomy. Surg Clin North Am 2000;80:1632–1673.

    Google Scholar 

  22. Miwa K, Kinami S, Taniguchi K, Fushida S, Fujimura T, Nonomura A. Mapping sentinel nodes in patients with early-stage gastric carcinoma. Br J Surg 2003;90:178–182.

    Article  PubMed  CAS  Google Scholar 

  23. Uenosono Y, Natsugoe S, Higashi H, Ehi K, Miyazono F, Ishigami S, Hokita S, Aikou T. Evaluation of colloid size for sentinel node detection using radioisotope in early gastric cancer. Cancer Lett 2003;200:19–24.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Yonsei University College of Medicine, 134 Shinchon-dong Seodaemun-gu, Seoul, 120-752, South Korea

    Chen Li, Sungsoo Kim, Ji Fu Lai, Sung Jin Oh, Woo Jin Hyung, Won Hyuk Choi, Seung Ho Choi & Sung Hoon Noh

  2. Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul, 120-752, South Korea

    Sungsoo Kim, Woo Jin Hyung & Sung Hoon Noh

  3. Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, 120-752, South Korea

    Sung Hoon Noh

  4. Department of Surgery, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China

    Chen Li

  5. Department of Surgical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, 310016, China

    Ji Fu Lai

Authors
  1. Chen Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sungsoo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ji Fu Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sung Jin Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Woo Jin Hyung
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Won Hyuk Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seung Ho Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sung Hoon Noh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sung Hoon Noh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Li, C., Kim, S., Lai, J.F. et al. Solitary Lymph Node Metastasis in Gastric Cancer. J Gastrointest Surg 12, 550–554 (2008). https://doi.org/10.1007/s11605-007-0285-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-007-0285-x

Keywords

Search

Navigation