J.Jpn. Surg. Soc.. 57(3): 387-395, 1956

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HISTOPATHOLOGIC STUDIES ON THE METASTASIS OF GASTRIC CARCINOMA IN THE REGIONAL LYMPH NODES, WITH SPECIAL REFERENEC TO THE RELATION OF THE METASTASIS WITH THE END RESULTS

Of the cases of ordinary gastrectomy (including subtotal gastrectomy) for gastric carinoma in our clinic between 1941 and 1954, 560 cases in which definite information could be obtained as to the end results of the operation were subjected to histopathologic examination with special reference to the regional lymph nodes. The results thus obtained on the relationships of the histopathologic findings of gastric carinoma with lymphatic metastasis and the end results are summarized in the following.
(1) Lymphatic metastasis was recognized in 477 (85.2%) of the 560 cases. The rates of occurrence of metastasis in lymph nodes at different positoins were as follows: 57.3% in the lesser curvature lymph nodes along the left gastric artery, 67.3% in the subpyrolic lymph nodes behind the pyrolus on the greater curvature side, 35.5% in the greater curvature lymph nodes along the omental branch of the right gastric artery, 33.0% in the left gastric artery lymph nodes surrounding the trunk of the left gastric artery, and 33.0% in the hepatic artery lympd nodes along the hepatic artery. When the occurrence of metastasis is considered with reference to the position of gastric carcinoma, however, the rate of metastasis was highest in the primary lymph nodes associated, on the whole, with the region of the gastric wall where the carcinoma was situated.
The rate of metastasis in the subpyrolic lymph nodes, however, was as high as 60 to 80%, irrespective of the position of the carcinoma. In the cases of greater curvature carcinoma (a carcinoma having its center in the greater curvature and extending on the anterior and posterior walls nearly equally), metastasis occurred in 31.9% of the hepatic artery lymph nodes, in 41.8% of the greater curvature lymph nodes, and in 31.9% ofthe lesser curvature lymph nodes, no significant differences being thus seen among these three percentages.
(2) Relation of lymphatic metastasis with the size of lymph nodes: The rate of metastasis was 71.5% for lymph nodes larger than the tip of the little finger, 37.7% for those of little finger tip to red bean size, and 24.9% for those smaller than the red bean,
(3) Comparison between macroscopic and histopathologic findings on metastasized lymph nodes: In 847 (46.7%) of 1858 metastasized lymph nodes, metastasis was definite macroscopically. On microscopic examination it was found that in all these 847 nodes from nearly half to all of the mass of a node had been occupied by metastatic carcinomatous cells.
(4) Relation of lymphatic metastasis with the size of gastric carcinoma : The rate of occurrence of metastasis was 66.1% in extremely small carcinomas (smaller than 9cm²), 84.9% in small carcinomas (10-19 cm²), 88.8% in medium-sized carcinoma (20-39 cm²), and 87.7% in larger carcinomas (larger than 40cm²)．
(5) Relation of lymphatic metastasis with the type of gastric carcinoma: When the carcinoma were classified after Borrmann, the rate of occurrence of metastasis was 80.8% for type I, 82.1% for type II, 91.3% for type III, and 91.3% for type IV.
When the carcinomas were classified histopathologically after Petersen, the rate of occurrence of metastasis was 80.3% for adenocarcinoma, 89.6% for carcinoma solidum, and 79.2% for carcinoma of mixed type.
Further, the rate was 94.6% for gelatinous carcinoma and 83.5% for non-gelatinous ones.
(6) Relation of lymphatic metastasis with the depth of carcinomatous infiltration of the gastric wall: The group including type S cases (in which carcinomatous infiltration extended to the subserosa) showed a higher rate of metastasis (91%) than the group including type Sm and type M cases (in which the infiltration did not extend beyond the gastric wall)(55%), and, indeed, in a large majority (76.5%) of the latter cases, metastasis was recognized only in the primary lymph nodes.
(7) Relation of lymphatic metastasis with the end results of the operation: In non-metastatic cases the 3-year and the 5-year survival rate were 76.2 and 60.5% respectivly, whereas in metastatic cases the rates were 31.3 and 25.5% respectively.
In the non-metastatic group of Sm and M cases the 3-year and the 5-year survival rate were 91,9 and 76.5% respectively, while the rates in the metastatic group were 82.6 and 76.4% respectively. Further, the non-metastatic group of type S cases showed a 3-year and a 5-year survival rate of 56. 7 and 50.0% respectively, while the metastatic group gave the rates of 18.6 and 12,1% respectively.
(author's abstract)

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