Vagina vasorum dissection during D2 lymphadenectomy for gastric carcinoma

Abstract

To explore the relationship between metastasis and vagina vasorum in the progress of gastric carcinoma and to find some facts and references for gastric surgeons. One hundred and seven specimens of left or right gastric arteries (55 left and 52 right) were gathered from 59 patients undergoing radical gastrectomy for gastric carcinoma. All the frozen specimens were cut into 3 microm-thick sections and stained with hematoxylin-eosin (HE) and immunohistochemical method separately. Cytokeratin (CK) and mesothelial cells (MC) were stained with immunohistochemical method. Cancer cells inside vagina vasorum were detected and the structure of artery wall was observed under microscope. Metastatic cancer cells or tubercles were found inside vagina vasorum in some stage III or IV specimens, but not in stage I or II specimens. Tumor cells in vagina vasorum were CK positive in 26 specimens of 14 tumors. Among them, stage III was found in 4 specimens of 2 tumors, and stage IV in 22 specimens of 12 tumors. None of these specimens was positive for MC. The positive rate of CK increased with TNM staging. Compared with the lower part, tumors in the upper and middle parts of stomach were more likely to metastasize into vagina vasorum. Vagina vasorum dissection should be performed during D2 lymphadenectomy for TNM stage III or IV gastric carcinoma.