S3.11
The number of regional lymph nodes involved and the total
number of regional nodes identified must be recorded.
CS3.11a
Regional lymph nodes are the perigastric nodes along the
lesser and greater curvatures and the nodes along the left
gastric, common hepatic, hepatoduodenal, splenic and
celiac arteries (see figures S1.12a and b). Lymph node
groups offer no significant prognostic information, and thus
all regional nodes can be reported together.1
CS3.11b
Record the number of lymph nodes from the main
resection specimen, and the regional nodes from each
separately labelled specimen.
CS3.11c
According to the AJCC, a “tumour nodule with smooth
contour in regional node area” is classified as a positive
node. In reference to the stomach specifically: “metastatic
nodules in the fat adjacent to a gastric carcinoma, without
evidence of residual lymph node tissue, are considered
regional lymph node metastases”. Note that similar
nodules on the peritoneal surface are considered M1.
Figure S1.12a
Regional lymph nodes. 1, 3, 5: perigastric nodes of the
lesser curvature. 2, 4a, 4b, 6: perigastric nodes along the
greater curvature. Involvement of nodes above the
diaphragm is defined as distant metastasis.
Figure S1.12b
Regional lymph nodes of the stomach. 7: left gastric nodes;
8: nodes along the common hepatic artery; 9: nodes along
the celiac artery; 10 and 11: nodes along the splenic artery;
12: hepatoduodenal
Figures 1.12a and b from AJCC Cancer Staging Atlas. Frederick L. Greene, Carolyn C.
Compton, April G. Fritz, Jatin P. Shah and David P. Winchester. 2006 Springer.
Reproduced with permission.