Primary Study On Metastasis Factors Of Subpyloric Lymph Nodes And It's Subgroup Lymph Nodes In Gastric Cancer

Objective:To explore the risk factors of subpyloric(No.6 group)and its subgroups lymph nodes metastasis of gastric cancer,so as to excise lymph nodes of No.6 group and its subgroups more reasonably during the clinical operation.Methods:1.Gastric cancer patients(excluding patients who had undergone neoadjuvant chemotherapy)were hospitalized continuously and underwent laparoscopy-assisted gastrectomy(LAG)with D2 lymph node dissection,and make sure they have complete clinicopathologic data.After surgery,all regional lymph nodes were individually retrieved from the adipose tissue of the surgical specimen.The No.6 nodes were divided into No.6i?No.6v?No.6a three substations: 6a is close to the right gastroepiploic artery(RGEA)from its first gastric branch to its root;6v is close to the right gastroepiploic artery(RGEV),between the root of the RGEA and the confluence of the anterior superior pancreatoduodenal vein(ASPDV),and 6i is adjacent to the infrapyloric artery(IPA).The lymph nodes and it's mesenterial tissue around were taken for pathological examination.2.Immunohistochemical staining technique was used to detect the micrometastasis of No.6 lymph nodes and its peripheral mesentery,that histopathological examination was negative.3.Data analysis: The clinicopathologic data were statistically compared using chi-square test and logistic regression analysis,and the test level was 0.05.Results:1.The metastatic rate of No.6 group lymph nodes was 36.4%(48/132)with 27.7%(247/ 891)of the resected lymph nodes involved.Among the metastatic rate of lymph nodes in three subgroup,No.6i subgroup is lower(9.1%,12/132)then No.6a(34.1%,45/132)and No.6v(17.4%,23/132).2.By statistical analysis,we confirmed that the metastasis of No.6 lymph nodes was correlated to tumor location ? Lauren type and the metastasis of No.4d?5?8 lymph nodes.The metastasis of No.6a lymph nodes was correlated to tumor location and the metastasis of No.4d?5?8 lymph nodes.The metastasis of No.6v lymph nodes were correlated to the distance between the lower margin of tumor and pylorus ring and the metastasis of No.4d?8 lymph nodes.The metastasis of No.6i subgroups was correlated to the distance between the lower margin of tumor and pylorus ring?the metastasis of No.5 and 8 lymph nodes.3.LMMs were found in 9 patients(18.4%,9/49)and 13 nodes(11.5%)by immunohistochemistry.11 LMMs came from patients with gastric cancer in L(5 in No.6a subgroup,3 in No.6v subgroup and 3 in No.6i subgroup),and 2 LMMs in M(both in No.6a subgroup).No micrometastasis exists in the mesentery.And we confirmed that the micrometastasis of lymph nodes was correlated to the metastasis of No.4d?8 lymph nodes in No.6 group and No.6a subgroup,the metastasis of No.8 lymph nodes in No.6v subgroup,and the distance between the lower margin of tumor and pylorus ring in No.6i subgroup.Conclusion:1.The metastasis of No.6 lymph nodes was correlated to tumor location?Lauren type and the metastasis of No.4d?5?8 lymph nodes.The metastasis of No.6a lymph nodes was correlated to tumor location and the metastasis of No.4d?5?8 lymph nodes.The metastasis of No.6v lymph nodes were correlated to the distance between the lower margin of tumor and pylorus ring and the metastasis of No.4d?8 lymph nodes.The metastasis of No.6i subgroups was correlated to the distance between the lower margin of tumor and pylorus ring?the metastasis of No.5 and 8 lymph nodes.2.the micrometastasis of lymph nodes was correlated to the metastasis of No.4d?8 lymph nodes in No.6 group and No.6a subgroup,the metastasis of No.8 lymph nodes in No.6v subgroup,and the distance between the lower margin of tumor and pylorus ring in No.6i subgroup.