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Vol 84, No 1 (2025): Folia Morphologica
Review article
Published online: 2024-09-16

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Anatomy of the lymphatics in normal stomach and gastric carcinomas

Dimosthenis Chrysikos1, Panagiotis Kanavaros12, Alexandra Barbouti2, Ameer Shehade1, Dimitrios Liatsos1, Alexandros Samolis1, Thoedore Troupis1
DOI: 10.5603/fm.101667
Pubmed: 39291447
Folia Morphol 2025;84(1):37-47.

Abstract

The lymphatic system is composed of lymphoid organs/tissues and a complex network of lymphatic vessels that transport interstitial fluid, antigens, lipids, immune cells, and other materials in the body. There is growing evidence that lymphatic vasculature is associated with many pathological conditions such as lymphoedema and cancer progression and metastasis. Thus, improved understanding of the anatomical features, the molecular profile, and the function of the lymphatic vasculature may provide innovative approaches for disease prevention and treatment. This article aims to present a comprehensive review of the gastric lymphatic anatomy and its importance in the pathology, treatment, and prognosis of gastric carcinomas.

Keywords: lymphaticsstomachgastric cancersurgical treatmentlymphadenectomyskip metastasis

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References

  1. Abdelfatah MM, Barakat M, Lee H, et al. The incidence of lymph node metastasis in early gastric cancer according to the expanded criteria in comparison with the absolute criteria of the Japanese Gastric Cancer Association: a systematic review of the literature and meta-analysis. Gastrointest Endosc. 2018; 87(2): 338–347.
    CrossRefPubMed
  2. Adamczyk LA, Gordon K, Kholová I, et al. Lymph vessels: the forgotten second circulation in health and disease. Virchows Arch. 2016; 469(1): 3–17.
    CrossRefPubMed
  3. Aiolfi A, Bona D, Bonitta G, et al. OGSA Group for Esophagogastric Surgery. Long-term impact of D2 lymphadenectomy during gastrectomy for cancer: individual patient data meta-analysis and restricted mean survival time estimation. Cancers (Basel). 2024; 16(2).
    CrossRefPubMed
  4. Ajani JA, D'Amico TA, Bentrem DJ, et al. Gastric Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022; 20(2): 167–192.
    CrossRefPubMed
  5. Ambrosio MR, Perotti B, Battini A, et al. Surgeon-pathologist team approach dramatically affects lymph nodes detection and improves patients' short-term outcome. Cancers (Basel). 2022; 14(4).
    CrossRefPubMed
  6. Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017; 67(2): 93–99.
    CrossRefPubMed
  7. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011; 14(2): 101–112.
    CrossRefPubMed
  8. Bahardoust M, Kheirabadi M, Donyadideh G, et al. Effect of the number of negative lymph nodes removed on the survival and recurrence rate after gastrectomy in patients with gastric cancer: a multicenter retrospective cohort study. BMC Surg. 2023; 23(1): 246.
    CrossRefPubMed
  9. Barchi LC, Yagi OK, Jacob CE, et al. Predicting recurrence after curative resection for gastric cancer: external validation of the italian research group for gastric cancer (GIRCG) prognostic scoring system. Eur J Surg Oncol. 2016; 42(1): 123–131.
    CrossRefPubMed
  10. Brisinda G, Chiarello MM, Fico V, et al. Pattern of distribution of lymph node metastases in individual stations in middle and lower gastric carcinoma. Cancers (Basel). 2023; 15(7).
    CrossRefPubMed
  11. Cho HS, Ahn JH. Nomenclature and lymphatic drainage patterns of abdominal lymph nodes. J Korean Soc Radiol. 2022; 83(6): 1240–1258.
    CrossRefPubMed
  12. Choi YY, An JiY, Guner A, et al. Skip lymph node metastasis in gastric cancer: is it skipping or skipped? Gastric Cancer. 2016; 19(1): 206–215.
    CrossRefPubMed
  13. Choi YY, An JiY, Katai H, et al. A lymph node staging system for gastric cancer: a hybrid type based on topographic and numeric systems. PLoS One. 2016; 11(3): e0149555.
    CrossRefPubMed
  14. Coburn N, Cosby R, Klein L, et al. Staging and surgical approaches in gastric cancer: a systematic review. Cancer Treat Rev. 2018; 63: 104–115.
    CrossRefPubMed
  15. da Costa PM, Lages P, Onofre S, et al. The impact of negative lymph nodes in the survival outcomes of pN+ patients following radical gastrectomy: the inverse lymph node ratio as a better score to study negative lymph nodes. Updates Surg. 2020; 72(4): 1031–1040.
    CrossRefPubMed
  16. de Jong MHS, Gisbertz SS, van Berge Henegouwen MI, et al. Prevalence of nodal metastases in the individual lymph node stations for different T-stages in gastric cancer: a systematic review. Updates Surg. 2023; 75(2): 281–290.
    CrossRefPubMed
  17. de Jongh C, Triemstra L, van der Veen A, et al. LOGICA Study Group. Pattern of lymph node metastases in gastric cancer: a side-study of the multicenter LOGICA-trial. Gastric Cancer. 2022; 25(6): 1060–1072.
    CrossRefPubMed
  18. de Manzoni G, Roviello F, Di Leo A. Lymhatic sread, lymh node stations, and levels of lymhatic dissection in gastric cancer. In: de Manzoni G, Roviello F, Siquini W. ed. Surgery in the multimodal management of gastric cancer. Sringer, Milan 2012: 15–23.
  19. Degiuli M, De Manzoni G, Di Leo A, et al. Gastric cancer: current status of lymph node dissection. World J Gastroenterol. 2016; 22(10): 2875–2893.
    CrossRefPubMed
  20. Deng J, Liang H, Sun D, et al. Prognosis of gastric cancer patients with node-negative metastasis following curative resection: outcomes of the survival and recurrence. Can J Gastroenterol. 2008; 22(10): 835–839.
    CrossRefPubMed
  21. Deng JY, Liang H. Clinical significance of lymph node metastasis in gastric cancer. World J Gastroenterol. 2014; 20(14): 3967–3975.
    CrossRefPubMed
  22. Di Leo A, Marrelli D, Roviello F, et al. Lymph node involvement in gastric cancer for different tumor sites and T stage: Italian Research Group for Gastric Cancer (IRGGC) experience. J Gastrointest Surg. 2007; 11(9): 1146–1153.
    CrossRefPubMed
  23. Douridas GN, Pierrakakis SK. Is there any role for D3 lymphadenectomy in gastric cancer? Front Surg. 2018; 5: 27.
    CrossRefPubMed
  24. Han KiB, Jang YJ, Kim JH, et al. Clinical significance of the pattern of lymph node metastasis depending on the location of gastric cancer. J Gastric Cancer. 2011; 11(2): 86–93.
    CrossRefPubMed
  25. Hsu MC, Itkin M. Lymphatic anatomy. Tech Vasc Interv Radiol. 2016; 19(4): 247–254.
    CrossRefPubMed
  26. Huang CM, Lin JX, Zheng CH, et al. Effect of negative lymph node count on survival for gastric cancer after curative distal gastrectomy. Eur J Surg Oncol. 2011; 37(6): 481–487.
    CrossRefPubMed
  27. Ishikawa S, Shimada S, Miyanari N, et al. Pattern of lymph node involvement in proximal gastric cancer. World J Surg. 2009; 33(8): 1687–1692.
    CrossRefPubMed
  28. Jeon CH, Park KiB, Lee H, et al. Refining gastric cancer staging: examining the interplay between number and anatomical location of metastatic lymph nodes — a retrospective multi-institutional study. BMC Cancer. 2023; 23(1): 1192.
    CrossRefPubMed
  29. Jeong Oh, Jung MiR, Kang JiH. Prognostic value of the anatomic region of metastatic lymph nodes in the current TNM staging of gastric cancer. J Gastric Cancer. 2021; 21(3): 236–245.
    CrossRefPubMed
  30. Jiang B, Zhou Li, Lu J, et al. Predictors of lymph node metastasis and residual tumor in early gastric cancer patients after noncurative endoscopic resection: a systematic review and meta-analysis. Therap Adv Gastroenterol. 2020; 13: 1756284820935033.
    CrossRefPubMed
  31. Jiang J, Chen J, Zhang H, et al. Combination of the ratio between metastatic and harvested lymph nodes and negative lymph node count as a prognostic indicator in advanced gastric cancer: a retrospective cohort study. J Gastrointest Oncol. 2021; 12(5): 2022–2034.
    CrossRefPubMed
  32. Kano K, Yamada T, Oshima T, et al. Association between lymph node ratio and survival in patients with pathological stage II/III gastric cancer. Ann Surg Oncol. 2020; 27(11): 4235–4247.
    CrossRefPubMed
  33. Kim DH, Choi MG, Noh JH, et al. Clinical significance of skip lymph node metastasis in gastric cancer patients. Eur J Surg Oncol. 2015; 41(3): 339–345.
    CrossRefPubMed
  34. Kinami S, Nakamura N, Miyashita T, et al. nPTD classification: an updated classification of gastric cancer location for function preserving gastrectomy based on physiological lymphatic flow. BMC Cancer. 2021; 21(1): 1231.
    CrossRefPubMed
  35. Kinami S, Nakamura N, Tomita Y, et al. Precision surgical approach with lymph-node dissection in early gastric cancer. World J Gastroenterol. 2019; 25(14): 1640–1652.
    CrossRefPubMed
  36. Kinami S, Saito H, Takamura H. Significance of lymph node metastasis in the treatment of gastric cancer and current challenges in determining the extent of metastasis. Front Oncol. 2021; 11: 806162.
    CrossRefPubMed
  37. Kurokawa Y, Doki Y, Mizusawa J, et al. Five-year follow-up of a randomized clinical trial comparing bursectomy and omentectomy alone for resectable gastric cancer (JCOG1001). Br J Surg. 2022; 110(1): 50–56.
    CrossRefPubMed
  38. Kwee RM, Kwee TC. Predicting lymph node status in early gastric cancer. Gastric Cancer. 2008; 11(3): 134–148.
    CrossRefPubMed
  39. Lee JH, Lee HJ, Kong SH, et al. Analysis of the lymphatic stream to predict sentinel nodes in gastric cancer patients. Ann Surg Oncol. 2014; 21(4): 1090–1098.
    CrossRefPubMed
  40. Li Y, Wu G, Liu J, et al. Log odds of positive lymph nodes as a novel prognostic predictor for gastric cancer: a systematic review and meta-analysis. BMC Cancer. 2023; 23(1): 523.
    CrossRefPubMed
  41. Li Y, Xie F, Xiong Q, et al. Machine learning for lymph node metastasis prediction of in patients with gastric cancer: a systematic review and meta-analysis. Front Oncol. 2022; 12: 946038.
    CrossRefPubMed
  42. Lirosi MC, Biondi A, Ricci R. Surgical anatomy of gastric lymphatic drainage. Transl Gastroenterol Hepatol. 2017; 2: 14.
    CrossRefPubMed
  43. Liu X, Long Z, Cai H, et al. Analysis of lymph node metastasis correlation with prognosis in patients with T2 gastric cancer. PLoS One. 2014; 9(8): e105112.
    CrossRefPubMed
  44. Liu Y, Cui H, Xu X, et al. Prognostic value of lymph node density on cancer staging system for gastric cancer without distal metastasis: a population-based analysis of SEER database. World J Surg Oncol. 2022; 20(1): 325.
    CrossRefPubMed
  45. López MJ, Carbajal J, Alfaro AL, et al. Characteristics of gastric cancer around the world. Crit Rev Oncol Hematol. 2023; 181: 103841.
    CrossRefPubMed
  46. López Sala P, Leturia Etxeberria M, Inchausti Iguíñiz E, et al. Gastric adenocarcinoma: a review of the TNM classification system and ways of spreading. Radiologia (Engl Ed). 2023; 65(1): 66–80.
    CrossRefPubMed
  47. Macalindong SS, Kim KH, Nam BH, et al. Effect of total number of harvested lymph nodes on survival outcomes after curative resection for gastric adenocarcinoma: findings from an eastern high-volume gastric cancer center. BMC Cancer. 2018; 18(1): 73.
    CrossRefPubMed
  48. Machlowska J, Baj J, Sitarz M, et al. Gastric cancer: epidemiology, risk factors, classification, genomic characteristics and treatment strategies. Int J Mol Sci. 2020; 21(11).
    CrossRefPubMed
  49. Marano L, Carbone L, Poto GE, et al. Extended lymphadenectomy for gastric cancer in the neoadjuvant era: current status, clinical implications and contentious issues. Curr Oncol. 2023; 30(1): 875–896.
    CrossRefPubMed
  50. Marrelli D, De Stefano A, de Manzoni G, et al. Prediction of recurrence after radical surgery for gastric cancer: a scoring system obtained from a prospective multicenter study. Ann Surg. 2005; 241(2): 247–255.
    CrossRefPubMed
  51. Maru P, Roy B, Sen S, et al. Imaging of gastric carcinoma. Part two: lymph node mapping in gastric carcinoma. J Gastrointest Abdom Radiol. 2021; 4(03): 206–213.
    CrossRef
  52. Mehrara BJ, Radtke AJ, Randolph GJ, et al. The emerging importance of lymphatics in health and disease: an NIH workshop report. J Clin Invest. 2023; 133(17).
    CrossRefPubMed
  53. Cancer Genome Atlas Research Network. Comprehensive molecular characterization of gastric adenocarcinoma. Nature. 2014; 513(7517): 202–209.
    CrossRefPubMed
  54. Oliver G, Kipnis J, Randolph GJ, et al. The lymphatic vasculature in the 21 century: novel functional roles in homeostasis and disease. Cell. 2020; 182(2): 270–296.
    CrossRefPubMed
  55. Park SS, Ryu JS, Min BW, et al. Impact of skip metastasis in gastric cancer. ANZ J Surg. 2005; 75(8): 645–649.
    CrossRefPubMed
  56. Petrova TV, Koh GY. Biological functions of lymphatic vessels. Science. 2020; 369(6500).
    CrossRefPubMed
  57. Rosa F, Costamagna G, Doglietto GB, et al. Classification of nodal stations in gastric cancer. Transl Gastroenterol Hepatol. 2017; 2: 2.
    CrossRefPubMed
  58. Rosa F, Schena CA, Laterza V, et al. The role of surgery in the management of gastric cancer: state of the art. Cancers (Basel). 2022; 14(22).
    CrossRefPubMed
  59. Shen KH, Wu CW, Lo SS, et al. Factors correlated with number of metastatic lymph nodes in gastric cancer. Am J Gastroenterol. 1999; 94(1): 104–108.
    CrossRefPubMed
  60. Singhal D, Börner K, Chaikof EL, et al. Mapping the lymphatic system across body scales and expertise domains: a report from the 2021 National Heart, Lung, and Blood Institute workshop at the Boston Lymphatic Symposium. Front Physiol. 2023; 14: 1099403.
    CrossRefPubMed
  61. Skandalakis JE, Skandalakis LJ, Skandalakis PN. Anatomy of the lymphatics. Surg Oncol Clin N Am. 2007; 16(1): 1–16.
    CrossRefPubMed
  62. Smyth EC, Nilsson M, Grabsch HI, et al. Gastric cancer. Lancet. 2020; 396(10251): 635–648.
    CrossRefPubMed
  63. Ulvmar MH, Mäkinen T. Heterogeneity in the lymphatic vascular system and its origin. Cardiovasc Res. 2016; 111(4): 310–321.
    CrossRefPubMed
  64. Wang Q, Liu G, Hu C. Molecular classification of gastric adenocarcinoma. Gastroenterology Res. 2019; 12(6): 275–282.
    CrossRefPubMed
  65. Wang X, Wang P, Wang W, et al. Evaluation of the prognostic value of negative to positive lymph node ratio in gastric cancer: results from multi-institutional cohorts from western and eastern datasets - Cohort study. Ann Med Surg (Lond). 2023; 85(6): 2348–2355.
    CrossRefPubMed
  66. Yonemura Y, Endou Y, Tabachi K, et al. Evaluation of lymphatic invasion in primary gastric cancer by a new monoclonal antibody, D2-40. Hum Pathol. 2006; 37(9): 1193–1199.
    CrossRefPubMed
  67. Young JJ, Pahwa A, Patel M, et al. Ligaments and lymphatic pathways in gastric adenocarcinoma. Radiographics. 2019; 39(3): 668–689.
    CrossRefPubMed
  68. Zhao B, Mei Di, Zhang J, et al. Impact of skip lymph node metastasis on the prognosis of gastric cancer patients who underwent curative gastrectomy. J BUON. 2019; 24(2): 693–700.
    PubMed
  69. Zhao B, Zhang J, Zhang J, et al. Anatomical location of metastatic lymph nodes: an indispensable prognostic factor for gastric cancer patients who underwent curative resection. Scand J Gastroenterol. 2018; 53(2): 185–192.
    CrossRefPubMed
  70. Zhu J, Xue Z, Zhang S, et al. Integrated analysis of the prognostic role of the lymph node ratio in node-positive gastric cancer: a meta-analysis. Int J Surg. 2018; 57: 76–83.
    CrossRefPubMed

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