On the lymphatics of the cardia

Endoscopic lymphoscintigraphy was performed on 29 patients. In 15 of 29 cases, Single Photon Emission Computed Tomography (SPECT) was performed to observe the lymphatics of the cardia. The rate of detection of paraaortic lymph nodes by SPECT was 66.6 %, and in particular the paraaortic lymph nodes in the upper portion of the left renal vein were detected at a rate of 58.3 %. The ascending lymph flow from the cardia to the mediastinum could be depicted by SPECT. The SPECT images and the distribution of accumulation of Tc-99m Rhenium colloid into the regional lymph nodes indicated a similar tendency to the actual metastatic rate of carcinoma of the cardia. Endoscopic lymphoscintigraphy with SPECT is considered to be useful for imaging the lymph flow from the cardia to the regional lymph nodes. On the other hand, the conventional planar image was poor in depicting lymph nodes, and was impossible in dynamic analysis. In the early stage of carcinoma of the cardia, if the area limited, proximal gastrectomy seems reasonable, but in progressive and deepseated cancer, it is suggested that it is necessary to remove the lymph nodes in a wide area, including the paraaortic lymph nodes, in addition to performing total gastrectomy. (author)