Gastric lymph node stations (JRSGC)
Gastric lymph node stations (JRSGC)
- Synonym: Nodal stations in gastric cancer; Lymph node mapping in gastric carcinoma
Definition
The classification of gastric lymph node stations according to the Japanese Research Society for Gastric Cancer (JRSGC) is a detailed system that numbers lymph nodes of abdomen into specific stations.
The lymph node stations are divided into groups based on their anatomical locations around the stomach. Initially, there were 16 groups, but this has expanded to 36 groups over the years. The original groups retained include stations 1, 2, 5, 7, 9, 10, and 15. Other groups such as 3, 4, 6, 8, 11, 12, 13, 14, and 16 have been subdivided into two or more groups. Additionally, new groups (17, 18, 19, 20, 110, 111, and 112) were added in subsequent editions.
This classification system is crucial for surgical planning and for ensuring precise lymph node dissection during gastrectomy.
Right paracardial lymph nodes are located on the right side of the cardia, along the first ramification of the ascending branch of the left gastric artery (cardio-esophageal branch). | ||
Left paracardial lymph nodes are located on the left side of the cardia, along the cardio-oesophageal branch of the left inferior phrenic arteries. | ||
Lesser curvature lymph nodes are located along the descending branch of the left gastric artery and along the right gastric artery distal to the first gastric branch. | ||
| Along the branches of the left gastric artery | |
| Along second branch and distal part of the right gastric artery | |
Greater curvature lymph nodes are divided into two groups separated by the Von Ghoete point, where right and left gastroepiploic arteries meet each other at full channel: a left group (4s) and a right group (4d) Moreover, the left group is divided into a proximal part (4sa) and a distal part (4sb). lymph nodes of the proximal part of left group 4 (4sa) are located around the short gastric vessels while lymph nodes of the distal part (4sb) are located along the left gastroepiploic vessels. lymph nodes of the right part of group 4 are located along the right gastroepiploic vessels, distal to the first gastric branch (boundary with infrapyloric lymph nodes). | ||
Along short gastric arteries in perigastric region | ||
| Left greater curvature lymph nodes along the left gastroepiploic artery (perigastric area) | |
| Right greater curvature lymph nodes along the second branch and distal part of the right gastroepiploic artery | |
Suprapyloric lymph nodes are located at the lesser curvature, immediately above the pylorus, along the right gastric artery and its origin. | ||
Infrapyloric lymph nodes are located at the greater curvature, immediately below the pylorus, at the confluence of the right gastroepiploic vein with the anterior inferior pancreaticoduodenal vein | ||
LNs along the trunk of left gastric artery between its root and the origin of its ascending branch. | ||
Common hepatic artery lymph nodes are located around the common hepatic artery from its root from the coeliac trunk to the branching off of the gastroduodenal artery. These lymph nodes are distinguished into an anterior part (8a), and a posterior part (8p). | ||
Anterosuperior nodes along the common hepatic artery | ||
Posterior nodes along common hepatic artery | ||
| Coeliac trunk lymph nodes are located immediately near the origins of the left gastric artery, the common hepatic artery, and the splenic artery | |
Splenic hilum lymph nodes are located at the splenic hilum, distal to the end of the pancreatic tail. The vascular boundary between 10 and 4sb lymph nodes is represented by the first gastric ramification of the left gastroepiploic. | ||
Splenic artery lymph nodes are located along the splenic artery and are distinguished into a proximal group (11p) and a distal group | ||
Proximal splenic artery lymph nodes from its origin to halfway between its origin and the pancreatic tail end | ||
Distal splenic artery lymph nodes from halfway between its origin and the pancreatic tail end. | ||
Hepatoduodenal ligament lymph nodes are located in the context of this ligament and include three separate groups: 12a: Along the proper hepatic artery, in the caudal half between the confluence of the right and left hepatic ducts and the upper border of the pancreas | ||
| Lymph nodes located along the proper hepatic artery | |
| Lymph nodes located along the bile duct, in the caudal half between the confluence of the right and left hepatic ducts and the upper border of the pancreas | |
| Lymph nodes along the portal vein in the caudal half between the confluence of the right and left hepatic ducts and the upper border of the pancreas | |
Retropancreatic lymph nodes are located on the posterior surface of the head of the pancreas cranial to the Vater’s ampulla along the superior and inferior branches of the posterior pancreaticoduodenal artery. The left lateral border of this location is marked by the portal vein, while the upper border is represented by the origin of posterior hepatoduodenal ligament lymph nodes | ||
SMV and SMA lymph nodes that are located along the confluence of the superior mesenteric vein (SMV) (14v) into the portal vein and along the origin of the superior mesenteric artery (SMA) (14a), at the root of the mesentery.The lateral border is represented by the confluence of the gastrocolic vein (gastrocolic trunk) into the SMV; the lower border is located at the confluence of the middle colic vein into the SMVand the upper border is represented by the origin of the SMA from the aorta, at the lower hedge of the pancreas. | ||
Nodes along superior mesenteric vein | ||
Nodes along superior mesenteric artery | ||
Middle colic lymph nodes are located in the transverse mesocolon around the middle colic artery and vein, from their origin/ confluence from/into the superior mesenteric vessels, till the mesocolic hedge of the transverse colon. | ||
Station number 16 includes four separate groups of lymph nodes around the abdominal aorta and inferior vena cava:
| ||
around the diaphragmatic aortic hiatus, over the anterior side of the aorta, from the inferior hedge of the hiatus to the upper border of the coeliac artery. | ||
over the anterior surface of the aorta, from the coeliac artery to the lower border of the left renal vein; | ||
around the anterior surface of the aorta and vena cava, from the lower border of the left renal vein to the upper border of the origin of the inferior mesenteric artery; right and left border are defined by the right border of the inferior vena cava and by the left gonadic vessels; | ||
around the anterior surface of the aorta and vena cava, between the upper border of the origin of the inferior mesenteric artery and the aortic bifurcation. | ||
located along pancreaticoduodenalis superior anterior vessels, on the anterior surface of the pancreatic head beneath the pancreatic sheath. | ||
located along the inferior border of the pancreatic body. | ||
Infradiaphragmatic lymph nodes are located in the infradiaphragmatic space predominantly along the subphrenic vessel | ||
Paraesophageal lymph nodes are located in the paraesophageal region in the diaphragmatic esophageal hiatus | ||
Paraesophageal lymph nodes in the lower thorax | ||
in the supradiaphragmatic space separate from the esophagus | ||
Posterior mediastinal lymph nodes separate from the esophagus and the esophageal hiatus |
References
Japanese Research Society for Gastric Cancer. The general rules for the gastric cancer study in surgery. Jpn J Surg 1973;3:61-71.
Rosa F, Costamagna G, Doglietto GB, Alfieri S. Classification of nodal stations in gastric cancer. Transl Gastroenterol Hepatol. 2017 Jan 17;2:2. doi: 10.21037/tgh.2016.12.03. PMID: 28217752; PMCID: PMC5313280.
Pulkit Maru Imaging of Gastric Carcinoma. Part Two: Lymph node mapping in Gastric Carcinoma. J Gastrointestinal Abdominal Radiol ISGAR 2021;4:206–213.
