Lymph nodes around the posterior gastric artery: their existence,
frequency, and clinical implications
· Masaharu Ishida
· Norihiko Sugisawa
· Megumi Murakami
· Tomoyuki Ono
· Hirofumi Imoto
· Takeshi Aoki
· Katsuyoshi Kudoh
· Shinobu Ohnuma
· Naoaki Sakata
· Takanori Morikawa
· Fuyuhiko Motoi
· Takashi Kamei
· Takeshi Naitoh
· Michiaki Unno
Received: 19 October 2017 / Accepted: 27 April 2018
© Springer Nature Singapore Pte Ltd. 2018
Purpose The lymphatic ﬂow along the posterior gastric artery (PGA) is considered of possible clinical importance in terms
of lymphatic metastasis; however, little is known about the lymph nodes (LNs) around this artery. The purpose of this study
was to establish if LNs exist around the PGA and to evaluate their clinical implications.
Methods We examined the tissues surrounding the PGA from 21 cadavers to search for LNs. We also investigated the pat‑
terns of lymphatic metastases in patients who underwent surgery for gastric neoplasms at our institute to detect their presence
along the PGA.
Results The PGA was identiﬁed in 11 cadavers, and LNs around the PGA were detected microscopically in 2 of these.
Lymphatic metastasis directly to the LNs at the splenic artery without any metastases was regarded as skip metastasis along
the PGA. Skip metastasis was found in two of ten patients who underwent surgery for remnant gastric cancer.
Conclusions The existence of LNs around the PGA was conﬁrmed, and based on our ﬁndings, lymphatic metastasis through
the PGA is possible in patients with remnant gastric cancer.
Keywords Posterior gastric artery · Lymph node metastasis · Remnant gastric cancer
The posterior gastric artery was ﬁrst described by Walther
in 1729 as a “gastric branch”. The present term, “posterior
gastric artery (PGA)” was introduced by Haller in 1745 .
The incidence of the PGA and its surgical importance was
described in detail by Suzuki et al. , and the term “PGA”
was oﬃcially adopted by the Federative International Com‑
mittee on Anatomical Terminology in 1980 . In general,
the PGA is considered to branch from the middle of the
splenic artery and to perfuse the posterior wall of the gastric
fundus; however, the appearance, frequency, and deﬁnition
of PGA diﬀer among reports [4, 5].
According to the Japanese Classiﬁcation of Gastric Car‑
cinoma, all gastric arteries except for the PGA, the fundic
branch of the left inferior phrenic artery (#2), the short
gastric arteries (#4sa), the left gastroepiploic artery (#4sb),
the right gastric artery (#5), the right gastroepiploic artery
(#6), and the left gastric artery (#7), have their own regional
lymph nodes (LNs) . As a result, the PGA and its accom‑
panying LNs are not included within the range of LN dissec‑
tion in the Japanese gastric cancer treatment guidelines [7,
8]. However, the LNs around the PGA might have clinical
importance since the possibility of lymphatic metastasis of
gastric cancer along the PGA has been proposed before .
The existence of LNs around the PGA has not been docu‑
mented clearly and little is known about the lymphatic ﬂow
along the PGA.
In this study, we searched for LNs around the PGA in
cadavers and conﬁrmed their existence. Then, we looked
for lymphatic metastasis along the LNs around the PGA in
patients with gastric neoplasms.
* Masaharu Ishida
Department of Surgery, Tohoku University Graduate
School of Medicine, 1‑1 Seiryo‑machi, Aobaku, Sendai,
Miyagi 980‑8574, Japan