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Pathways of Lymph Node Metastases in Cancer of the Gastrointestinal and Hepatobiliary Tracts

Chusilp Charnsangavej, M.D.

Lymph node metastasis from malignant tumors of the gastrointestinal tract and abdominal organs generally follows lymphatic pathways in the peritoneal ligaments and mesentery or mesocolon that attach the organs to the retroperitoneum and abdominal wall.1 The pathways of lymphatic drainage accompany the blood vessels supplying or draining the organs, and they are located within the peritoneal ligaments, mesentery, or mesocolon. These blood vessels serve as anatomic landmarks on imaging studies such as CT and MRI. Understanding the pathways of lymph node metastasis helps to identify the expected sites of lymph node metastasis in the staging of cancers originating from the abdominal organs, for surgical planning, and for evaluating patients with suspected recurrent disease after the treatment.

This chapter defines the anatomy of the blood vessels within the peritoneal ligaments, mesentery, and meso-colon as seen on CT or MR imaging and describes the pathways of lymph node metastasis from malignant tumors originating from the gastrointestinal tract and hep-atobiliary tracts. The discussion focuses on the organs in the supramesocolic compartment, which include the liver, stomach, and spleen, and in the inframesocolic compartment, which include the colon and small bowel.

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