Lymph node metastases of gastric cancer. General pattern in 1931 patients.

The incidence of metastases from gastric adenocarcinoma to various regional lymph node stations was studied after meticulous node dissection and correlated to survival in 1931 resected patients. The incidence of metastases increased with deeper tumor invasion into the stomach wall. Deposits were most common in some perigastric node stations, and their distribution was clearly related to the location of the tumor. Some nonperigastric node stations also were frequently involved, e.g., those around the left gastric artery or in the splenic hilum, and may be considered primary draining nodes. Skip metastases to distant nodes were found in a few per cent of perigastric node-negative patients. Deposits in nodes around the middle colic artery, but not in any other upper abdominal node stations, were incompatible with 5-year survival rates. The analysis favors a so-called R2 or more extensive resection for cancers invading beyond the submucosa.