There are lymph nodes in the abdominal cavity 5 years after gastric cancer surgery

We always wait until we are seriously ill before seeking medical treatment. In fact, we can accumulate some medical knowledge. Have you ever known that the recurrence rate of abdominal lymph nodes in gastric cancer patients after surgery is high? This point of view is not very clear to us, so we must know and understand that the recurrence rate of abdominal lymph nodes in gastric cancer patients after surgery is high.

Recurrence of abdominal lymph nodes after gastric cancer surgery is related to whether the patient has perigastric or intra-abdominal lymph node metastasis before surgery, and whether the lymph node dissection during gastric cancer surgery is thorough.

(1) Abdominal lymph node recurrence rate: According to statistics from all over Japan in 1966, the lymph node recurrence rate was 10%. The general report ranges from 1.9% to 11.7%.

(2) Causes and pathways of abdominal lymph node metastasis: Malignant tumor cells are more likely to disperse than normal tissues. This is because tumor tissues contain low calcium, cancer tissues release hyaluronidase, and tumor interstitial fluid contains high levels of lysosomes and tissue proteases, which promote tumor cells to disperse from the tumor entity and penetrate the basement membrane and connective tissue gaps by amoeboid movement. Capillary lymphatic vessels have high permeability and generally do not have a complete basement membrane. There are temporary cracks between endothelial cells, making it easy for tumor cells to penetrate into the lymphatic vessels by amoeboid movement. Qi Chunlian et al. reported 125 cases of advanced gastric cancer in China, of which 20 cases had lymphatic emboli, accounting for 16%. There were 105 cases without lymphatic emboli, accounting for 84%. The lymph node metastasis rate of the former was 100%. The latter was 70.48%.

Tumor cells can reach the intermediate sinus and medullary sinus of lymph nodes and proliferate in lymphatic vessels as single tumor cells or tumor cells in 30 to 60 minutes. Sometimes tumor cells can bypass lymph nodes and metastasize to the next station lymph nodes, which is called jump metastasis. It is generally believed that lymph nodes have mechanical filtering and biological barrier functions, that is, tumor cells can be killed by the immune response of lymph nodes. Therefore, it does not mean that all lymph nodes metastasize. Explanations in this regard include the "seed and soil" theory proposed by Paget and the "dynamic" hypothesis proposed by Ewing. It has been mentioned before that metastatic tumor cells in lymphatic channels mainly come from primary lesions that directly invade lymphatic vessels to lymph nodes. Tumor cells in the blood circulation can invade lymphatic vessels to lymph nodes through tissue gaps. Tumor cells that enter the venous circulation can form the first metastatic focus in the lungs, and can further form the second and third metastatic focuses.

(3) Study on the degree of lymph node metastasis in gastric cancer patients: It is well known that the analysis of the number of lymph node metastasis and recurrent lymph node metastasis in gastric cancer is of greater importance for the prognosis of gastric cancer and the guidance of its further treatment. Therefore, foreign reports have shown that a total of 10,134 accessory lymph nodes were detected in 338 gastric cancer surgical cases, with an average of about 30 per patient. The ratio of the number of metastatic lymph nodes in each gastric cancer patient to the total number of lymph nodes detected is called the degree of lymph node metastasis. The above patients were divided into four groups according to the degree of metastasis: 0%, -25%, -50%, and >50%. The 5-year survival rate of the 0% metastasis group was 73% during follow-up; 43% in the -25% group; 22.6% in the -50% group; and 7.4% in the >50% group, indicating that the 5-year survival rate decreases with the increase of lymph node metastasis. In addition, with the increase of metastasis, the proliferation of sinus tissue cells decreases. The infiltration of gastric cancer interstitial lymphocytes decreases with the increase of metastasis. The depth of the tumor and the degree of invasion of the gastric serous surface are directly proportional to the increase in metastasis. Therefore, the degree of lymph node metastasis is a good prognostic factor, and combined with other factors, it can better reflect the biological characteristics of gastric cancer.

(4) Clinical manifestations: The clinical manifestations vary depending on the location of the recurrent lymph nodes. For example, if the lymph nodes recur in the retroperitoneum around the celiac artery and the abdominal aorta, the patient often presents with back pain, inability to lie supine, and sitting with the body bent forward. If the lymph nodes at the head of the pancreas and the lower end of the bile duct recur and swell, the patient may present with progressive obstructive jaundice syndrome. If the lymph nodes at the transverse colon and small intestinal mesentery recur, the patient may present with varying degrees of obstruction, and sometimes a mass may be palpated in the abdomen.

(5) Diagnosis: In addition to clinical examination, ultrasound or CT examination is generally not difficult to confirm.

(6) Treatment: Recurrence of abdominal lymph nodes after gastric cancer surgery is often caused by incomplete lymph node dissection during the first surgery, which results in the development and enlargement of lymph node metastases, or by the difficulty of lymph node dissection during the second surgery due to the metastasis of the first or second metastatic lesions. In addition to surgery to relieve intestinal or biliary obstruction, radiotherapy or chemotherapy are usually used. For example, during surgery to relieve obstruction, metal clamps can be used to mark the range of lymph node recurrence to facilitate accurate radiotherapy. A drug pump can also be placed in the blood vessel for postoperative arterial chemotherapy, which is better than general intravenous chemotherapy and has less toxic side effects.

The editor would like to summarize the above article to tell you that the recurrence rate of abdominal lymph nodes in gastric cancer patients after surgery is high. Once we understand this principle, we can apply it to our lives.