In gastric cancer, which lymph node groups are most commonly involved?

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Lymph Node Involvement in Gastric Cancer

In gastric cancer, the perigastric lymph nodes along the lesser curvature (stations 1,3,5) and greater curvature (stations 2,4,6) are most commonly affected first, followed by nodes along the left gastric artery (station 7), common hepatic artery (station 8), celiac artery (station 9), and splenic artery (stations 10,11). 1

Regional Lymph Node Classification

The Japanese classification system defines lymph node stations 1-12 and 14v as regional gastric lymph nodes, with metastasis to other nodes classified as distant metastases (M1). 1 For tumors invading the esophagus, stations 19,20,110, and 111 are also considered regional. 1

N1 Perigastric Nodes (Most Commonly Affected)

The perigastric lymph node stations include: 1

  • Station 1: Right paracardial nodes along the first branch of the ascending limb of the left gastric artery 1
  • Station 2: Left paracardial nodes along the esophagocardiac branch 1
  • Station 3: Lesser curvature nodes (subdivided into 3a and 3b) 1
  • Station 4: Greater curvature nodes (subdivided into 4sa, 4sb, 4d) 1
  • Station 5: Suprapyloric nodes along the right gastric artery 1
  • Station 6: Infrapyloric nodes along the right gastroepiploic artery 1

Research on solitary lymph node metastases demonstrates that 86% (44 of 51 cases) of single-node involvement occurs in these N1 perigastric regions. 2

N2 Regional Nodes (Second Tier)

The second tier of commonly affected nodes includes: 1

  • Station 7: Nodes along the trunk of the left gastric artery 1
  • Station 8: Nodes along the common hepatic artery (anterosuperior 8a and posterior 8p) 1
  • Station 9: Celiac artery nodes 1
  • Station 10: Splenic hilar nodes 1
  • Station 11: Splenic artery nodes (proximal 11p and distal 11d) 1

In cases with solitary metastasis showing skip patterns, station 7 (left gastric artery) is most frequently involved, followed by stations 8 and 12. 2

Tumor Location-Specific Patterns

Upper Third Stomach Tumors

For tumors in the upper third, the most commonly affected nodes are: 3

  • Right paracardial nodes (station 1) - most frequent 3
  • Left paracardial nodes (station 2) 3

Middle Third Stomach Tumors

For middle third tumors: 3

  • Lesser curvature nodes (station 3) - 10 of 28 cases 3
  • Left gastric artery nodes (station 7) - 6 of 28 cases 3
  • For lesser curvature tumors specifically, 25% (5 of 20) spread to station 7 3
  • For greater curvature tumors, 25% (2 of 8) metastasize to splenic hilar nodes (station 10) 3

Lower Third Stomach Tumors

For lower third tumors, the pattern shows: 3

  • Lesser curvature nodes (station 3) - 13 of 52 cases 3
  • Infrapyloric nodes (station 6) - 19 of 52 cases 3
  • Among lesser curvature tumors, 31% (9 of 29) involve station 6 3

Important Clinical Considerations

Skip Metastases

Approximately 14% of solitary lymph node metastases demonstrate skip patterns, bypassing N1 nodes to involve N2-N3 stations directly. 2 The most common skip metastasis sites are stations 7,8, and 12. 2 This phenomenon occurs even in tumors with submucosal invasion, emphasizing the need for systematic regional lymph node dissection rather than limited perigastric dissection. 2

Prognostic Significance

The distance of perigastric nodes from the primary tumor does not significantly affect prognosis when comparing nodes within 3 cm versus beyond 3 cm from the tumor. 4 However, far-extragastric nodes (stations 10-12) demonstrate significantly worse survival in N1 and N2 stages compared to perigastric or near-extragastric nodes. 5

Surgical Implications

D2 lymphadenectomy is the standard approach, requiring dissection of both perigastric nodes (D1) and nodes along the common hepatic artery, celiac artery, splenic hilum, and splenic artery. 6, 7 At least 16 lymph nodes should be examined for adequate staging. 1, 6, 7

For station 10 (splenic hilum) dissection, specific indications include: 6

  • Tumor size > 6 cm 6
  • Location in the greater curvature and middle-upper third 6
  • Preoperative staging T3-4 6

Routine splenectomy is not required and should be avoided unless the spleen or hilum is directly involved. 1, 6, 7

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

4
Research

Perigastric lymph node metastases in gastric cancer: comparison of different staging systems.

Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 1999

6
Guideline

Surgical Resection of Primary Tumor in Gastric Cancer with Peri-Hilar Lymph Node Involvement

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

7
Guideline

Abdominal Lymph Node Care Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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