title: Effects of initial disease status on lymph flow following gastrectomy in cases of carcinoma in the remnant stomach.
abstract: OBJECTIVE
  In cases of carcinoma in the remnant stomach (CRS), the lymphatic flow may be altered by the initial surgery. In this study of CRS after gastrectomy, we investigated how the regions of lymph node metastasis and changes in lymphatic flow depend on initial disease status.
  
  
  METHODS
  The study included 76 patients with CRS who underwent gastrectomy between September 2002 and November 2014. We analyzed and compared the clinicopathological factors and survival periods between patients after distal gastrectomy for malignant disease (group M, 33 patients) and patients after distal gastrectomy for benign disease (group B, 43 patients).
  
  
  RESULTS
  The depth of tumor invasion was more advanced in group B (T1/T2/T3/T4: group M 18/1/7/7, group B 8/11/8/16; P = 0.002). However, the degree of lymph node metastasis did not differ significantly between the two groups. The incidence of lymph node metastasis was high at stations 2 (19 %), 4sa (17 %), 10 (25 %), 11p (19 %), and 11d (27 %) in group M and 1 (14 %), 3 (23 %), and 4sb (15 %), and the mesojejunal lymph node (21 %) in group B. Lymph node dissection was highly beneficial at station 3, station 7, and the mesojejunum in both groups, but not at stations 10 or 11d.
  
  
  CONCLUSIONS
  As compared with group B, group M showed higher incidences of lymph node metastasis in the greater curvature, splenic hilum, and lymph nodes along the splenic artery, suggesting the predominance of lymphatic flows from the greater curvature to the splenic hilum and from the remnant stomach to the splenic artery.
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan.
authors.forename: Shinsaku
authors.initials: S
authors.lastname: Honda
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan.
authors.forename: Etsuro
authors.initials: E
authors.lastname: Bando
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Makuuchi
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Tokunaga
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tanizawa
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan.
authors.forename: Taiichi
authors.initials: T
authors.lastname: Kawamura
authors.affiliation: Division of Gastroenterological Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Teiichi
authors.initials: T
authors.lastname: Sugiura
authors.affiliation: Division of Gastroenterological Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kinugasa
authors.affiliation: Division of Gastroenterological Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Uesaka
authors.affiliation: Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan. m.terashima@scchr.jp.
authors.forename: Masanori
authors.identifier: http://orcid.org/0000-0002-2967-8267
authors.initials: M
authors.lastname: Terashima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy; D018530:Gastric Stump / Q000503:physiopathology*; D006801:Humans; D008196:Lymph; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis
keywords: Carcinoma in the remnant stomach; Lymphatic flow; Splenectomy