A study on the hepatic artery lymph node micrometastases of distal gastric cancer

Abstract

Objective To study the dissecting necessity of lymph node around normal and abnormal hepatic artery in distal gastric cancer undergoing D2 lymphadenectomy. Methods Sixty gastric cancer patients receiving distal D2 lymphadenectomy by the same surgeon between June 2008 to June 2010 at the Department of Gastrointestinal Surgery, First Affiliated Hospital of the Guangxi Medical University were included in this study. The lymph adipose tissue around the anatomically normal and aberrant hepatic artery was carefully dissected, and the lymph nodes sent for recombinant human cytokeratin 20 (CK20) and carcino-embryonic antigen ( CEA ) micrometastasis immunohistochemistry.Results With the micrometastasis immunohistochemistry of CK20 and CEA, we found the metastasise rate of lymph node around the normal hepatic artery was 27％. Patient age, tumor size, Borrmann type, TNM staging were correlated with the lymph node metastase. There were 7 cases with abnormal hepatic artery originating from the superior mesenteric artery. The hepatic artery ran in front of the pancreas in 1 case and behind the pancreas in 6 cases. We found there are no metastases in the lymph adipose tissue surrounding the abnormal artery. Conclusions CK20,CEA are suitable immunohistochemical targets for estimating the lymph node micrometastasis. In distal gastric cancer age at 60 or older years, tumor larger than 3 cm and Borrmann Ⅲ-Ⅳ type were risk factors for metastasis of lymph nodes around normal hepatic artery, while aberrant hepatic arteries originating from the superior mesenteric artery are much less likely to have positive lymph nodes in D2 lymphadenectomy. Key words: Stomach neoplasms; Hepatic artery; Lymphatic metastasis