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AIM:To study the localization of the solitary metastases inrelation to the primary gastric cancers and the feasibilityof sentinel lymph node(SLN)concept in gastric cancer.METHODS:Eighty-six patients with gastric cancer,whohad only one lymph node involved,were regardedretrospectively as patients with a possible sentinel nodemetastasis,and the distribution of these nodes wereassessed.Thirteen cases with jumping metastases werefurther studied and followed up.RESULTS:The single nodal metastasis was found in thenearest perigastric nodal area in 65.1%(56/86)of thecases and in 19.8%(17/86)of the cases in a fairly remoteperigastric area.Out of 19 middle-third gastric cancers,3 tumors at the lesser or greater curvatures had transversemetastases.There were also 15.1%(13/86)of patientswith a jumping metastasis to N2-N3 nodes without N1involved.Among them,the depth of invasion was mucosal(M)in 1 patient,submucosal(SM)in 2,proper-muscular(MP)in 4,subserosal(SS)in 5,and serosa-exposed(SE)in 1.Five of these patients died of gastric cancerrecurrence at the time of this report within 3 years aftersurgery.CONCLUSION:These results suggest that nodalmetastases occur in a random and multidirectional processin gastric cancer and that not every first metastatic node islocated in the perigastric region near the primary tumor.The rate of“jumping metastasis”in gastric cancer is muchhigher than expected,which suggests that the blindexamination of the nodal area close to the primary tumorcan not be a reliable method to detect the SLN and that aextended lymph node dissection(ELND)should beperformed if the preoperative examination indicatessubmucosal invasion.
AIM: To study the localization of the solitary metastases inrelation to the primary gastric cancers and the feasibility of sentinel lymph node (SLN) concept in gastric cancer. METHODS: Eighty-six patients with gastric cancer, whohad only one lymph node involved, were considered as part of as patients with a possible sentinel nodemetastasis, and the distribution of these nodes were assessed.Thirteen cases with jumping metastases werefurther studied and followed up .RESULTS: The single nodal metastasis was found in the nearby perigastric nodal area in 65.1% (56/86) of thecases and in 19.8% (17/86) of the cases in a fairly remote perigastric area. Out of 19 middle-third gastric cancers, 3 tumors at the lesser or greater curvatures had transverse metastases. There were also 15.1% (13/86) of patients with a The metastasis to N2-N3 nodes without N1involved. Among them, the depth of invasion was mucosal (M) in 1 patient, submucosal (SM) in 2, proper- muscular (MP) in 4, subserosal (SS) in 5, and serosa-exposed (SE) in 1.Five o f these patients died of gastric cancerrecurrence at the time of this report within 3 years aftersurgery. CONCLUSION: These results suggest that nodalmetastases occur in a random and multidirectional processin gastric cancer and that not every first metastatic node is located in the perigastric region near the primary tumor The rate of “jumping metastasis” in gastric cancer is muchhigher than expected, which suggests that the blindexamination of the nodal area close to the primary tumorcan not be a reliable method to detect the SLN and that aextended lymph node dissection (ELND) should beperformed if the preoperative exercise indicatessubmucosal invasion.