Reaserch About The Lymphatic Flow Of The Gastric Cardia And Lymph Node Metastasis Regularity For The Carcinoma Of Esophagogastric Junction

Objective: The cardia is the anatomical borderline between the esophagus and proximal gastric , which is the junction for squamous epithelium and columnar epithelium in histology. The adencarcinoma of esophagogastric junction (AEG) has a significantly rising incidence, with difficulty in early diagnosis,and poor survival.Tumor involvement of lymph nodes is commonly considered to be the major prognostic influencing factor. The esophagogastric junction (EGJ) is a special anatomical position,which has two-direction lymphatic flow.It is of great help to make stugy about the lymphatic flow of cardia for choosing a reasonable surgery programme,and perform lymphadenectomy scientificly and accurately to improve prognosis.The purpose of this study is to make research on the lymphatic flow of cardia, and lymph node metastasis regularity for the carcinoma of esophagogastric junction.It can provide reliable results for clinical diagnosis and treatment.Methods:Study 1.The research included inpatients under surgical treatment during 1993-2007,in the First Affiliated Hospital of Dalian Medical University.Statistical analysis was carried out for lymph nodes metastasis, and survival.Study 2.The lymph nodes were detected for micrometastasis by using CK-20 immunohistochemitry.Study 3.During 2007.6-2007.12,in the First Affiliated Hospital of Dalian Medical University,all patients surffered from AEG were choosen for research.The CH44 was used for analysising the lymphatic flow of cardia, and detecting the micrometastasis of the lymph nodes.Result:1.The database was established with 264 cases,and 131 cases were followed up by telephon after operation.The total number of lymph nodes,examined by HE stain,are 2884,which is 10.92 in average.There are 188 patients(71.2%) with lymph node metastasis,and 76(28.8%) without lymph node metastasis.2.Tumor size,Borrmann's classification,T,N,M are all lymph node metastasis influencing factors.Lymph nodes metastasis rates in No.1,No.3, No.7,No.9,No.16 were relatively high,so this flow accounted for 29.55% in total.3.There are 573 lymph nodes without metastasis from 36 patients, which are detected by HE stain.All were detected by CK-20 immunohistochemical for micrometastasis.The micrometastasis were detected in 17 lymph nodes, which were No.1(7),No.2(4),No.3(5),and No.7(1).4.In patients with AEG,CH44 was injected during operation to gain an observation of lymphatic flow.It can show the trends of lymph node metastasis,but the lymph node metastasis diagnostic value is 0.614 in accuracy.5.The predictive factors for the survival time after surgry are T, N, Stage.The lymph node metastasis is risk factor for survival.Conclusion:1. The lymphatic flow of the cardia: Abdomen lymphatic flowNo.1→No.3→No.7→No.9→No.16.This lymphatic flow is the most important one,and should pay more attention during operation.Pleural lymphatic flows: The main lymphatic flow is No.111,110.2.With the invasion of the carcinoma in depth,lymph node metastasis expand from the first to the third station,and so appears thoracic lymph node metastasis gradually.3.Lymph nodes dissection should be performed only though abdominal approach for those patients surffered from AEG.The limited or reduced surgery should performed in T1 and T2 stage patients.While for T3 and T4 stage patients,lymph node dissection could operate though abdominal approach mainly,especially for those patients with negative esophageal resection margin.