title: First drainage lymph node(s) in gastric cancer: analysis of the topographical pattern of lymph node metastasis in patients with pN-1 stage tumors.
abstract: BACKGROUND
  We attempted to identify the first lymph node(s) involved in metastasis of gastric cancer by studying the topographical pattern of metastasis to regional lymph nodes in patients with pN-1 stage tumors.
  
  
  METHODS
  A total of 190 patients (108 males and 82 females; age range, 27 to 83 years; mean, 59.7 years), who had undergone curative resection combined with lymphadenectomy for solitary carcinoma of the stomach and were histologically diagnosed as having pN-1 stage tumors, were enrolled in the present study. The topographical patterns of metastasis to regional lymph nodes were reviewed from the pathology records of these patients.
  
  
  RESULTS
  A total of 7561 lymph nodes (mean, 39.8/patient; range 15-99/patient) were dissected and metastasis was histologically observed in 523 nodes (6.9%, mean, 2.7/patient). Although perigastric lymph nodes were a common site of metastasis, the distribution of positive nodes depended on tumor location. As the number of positive nodes increased, a more diffuse pattern of regional involvement was noted. Skip metastasis was identified in 10 (5%) out of 190 patients. This unusual pattern of metastasis was found in 9 (14%) out of 63 patients with single positive nodes, while only one (1%) out of 127 patients with 2-6 positive nodes exhibited this pattern of metastasis. The difference between the two groups was statistically significant (p < 0.0001).
  
  
  CONCLUSIONS
  Although perigastric lymph nodes are important first sites of drainage from pN-1 stage gastric tumors, the pattern of lymph node metastasis varies widely within a regional area even in pN-1 stage patients.
authors.affiliation: Department of Surgery, Kitasato University, School of Medicine, 1-15-1, Kitasato, Sagamihara-shi, Kanagawa 228, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Kikuchi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kurita
authors.forename: Katada
authors.initials: K
authors.lastname: Natsuya
authors.forename: Shinichi
authors.initials: S
authors.lastname: Sakuramoto
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Shimao
authors.forename: Akira
authors.initials: A
authors.lastname: Kakita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000473:pathology*