PTD classification: proposal for a new classification of gastric cancer location based on physiological lymphatic flow
| Autor: | Zen Yoh, Takashi Fujimura, Hideto Fujita, Genichi Nishimura, Itasu Ninomiya, Masato Kayahara, Eisuke Ojima, Toshihiko Ojima, Hiroyuki Takamura, Hiroshi Funaki, Shinichi Kinami, Sachio Fushida, Tetsuo Ohta |
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| Rok vydání: | 2007 |
| Předmět: |
Adult
Male medicine.medical_specialty Left gastric artery medicine.medical_treatment Dissection (medical) Right gastroepiploic artery Gastrectomy Stomach Neoplasms medicine.artery medicine Humans Lymph node Aged Lymphatic Vessels Aged 80 and over business.industry Sentinel Lymph Node Biopsy Hematology General Medicine Sentinel node Middle Aged medicine.disease Surgery medicine.anatomical_structure Lymphatic system Oncology Lymphatic Metastasis Lymph Node Excision Female Radiology business Right gastric artery |
| Zdroj: | International journal of clinical oncology. 13(4) |
| ISSN: | 1341-9625 |
| Popis: | We propose a new classification for the location of gastric cancer — the PTD classification (i.e., zones P, T, and D; see below), with the zones classified according to the physiological lymphatic flow. Three hundred and thirty-six patients with T1 or small T2 gastric cancer who underwent sentinel node mapping at our hospital were enrolled. The relationship between the location of the gastric cancer and the physiological lymphatic flow derived from sentinel node mapping was investigated. Lymphatic basins were defined as lymphatic zones divided by the stream of stained lymphatic canals. One hundred and forty-six patients underwent standard gastrectomy with more than D2 dissection and the other 190 patients underwent function-preserving gastrectomy with the omission of lymph node dissection outside the lymphatic basin. In the former group, the progression pattern of lymph node metastasis was observed; nodal metastasis occurred in sentinel nodes first, and rarely extended outside the lymphatic basin. In the latter group, none of the patients have had a recurrence. The PTD classification we propose is as follows: the dividing line between the proximal region (zone P) and the transitional region (zone T) is the line that links the point of the watershed between the left gastroepiploic artery and right gastroepiploic artery, to the point that is the inflow point of the first descending branch of the left gastric artery; and the dividing line between zone T and the distal region (zone D) is an arc at a radius of 8 cm from the pylorus. There were no lymphatic basins within the right gastric artery area for tumors located in zone T. The advantage of the PTD classification is that if the PTD classification were to be used as a guide for gastric resection procedures, preservation of the pylorus would become possible without diminishing the prognosis in patients with cT1N0 cancer located in zone T. |
| Databáze: | OpenAIRE |
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