Architectonics of the lymphatic system
The lymphatic system of the organ is subdivided into intraorgan and extraorgan parts.
Intraorgan vessels penetrate all layers of the gastric wall. The capillary networks of the mucosa, submucosa, muscular layer, and serosa are interconnected by anastomoses and form efferent vessels.
Extraorgan vessels provide lymph drainage outside the organ:
- From the lesser curvature (in the region of the cardia and body), lymphatic vessels run along blood vessels into the lesser omentum to first-tier nodes, and then to second-tier nodes.
- From the greater curvature, vessels follow the course of the short gastric and gastro-omental blood vessels to regional nodes.
Regional lymph nodes
The lymph nodes of the gastric region have a clear hierarchy:
- First-tier nodes: for the region of the splenic hilum, as well as the tail and body of the pancreas, this role is performed by subpyloric and superior mesenteric formations.
- Celiac lymph nodes (nodi lymphatici coeliaci):
- Their number ranges from one to three.
- They are localized directly at the celiac trunk.
- They act as the main regional second-tier nodes not only for the stomach, but also for the duodenum, liver, pancreas, and splenic hilum.
- They provide further lymph drainage into the caval and aortic lymph nodes.
Clinical significance of lymph drainage
Knowledge of the topography of the lymphatic bed is of critical importance in abdominal surgery and oncology. When performing gastric resection for malignant neoplasms (cancer), surgical tactics strictly require the mandatory removal of both first- and second-tier regional lymph nodes. This is necessary to prevent tumor metastasis via lymphatic pathways collecting lymph from the affected area.
Sources of gastric innervation
Nervous regulation of the organ is provided by sympathetic and parasympathetic influences. The following structures participate in innervation:
- Branches of the anterior and posterior vagal trunks.
- Celiac plexus (plexus coeliacus).
- Derivatives of the celiac plexus, which include the superior and inferior gastric, hepatic, splenic, and superior mesenteric plexuses.
Briefly: answers to topical questions
Which lymph nodes are the first-tier nodes for the lesser curvature of the stomach?
For the lesser curvature of the stomach, the first-tier nodes are the left and right gastric lymph nodes, which lie in the region of the lesser curvature along the left and right gastric arteries.
- Left and right gastric lymph nodes (nodi lymphoidei gastrici sinistri et dextri) lie in the region of the lesser curvature of the stomach, located along the course of the left and right gastric arteries.
Specifically which branches do the anterior and posterior vagal trunks give off to the stomach?
The cited sources detail the branches of the anterior vagal trunk to the stomach: upon approaching the stomach, it breaks up into branches to the anterior surface; it gives off 3–6 branches to the esophagus, cardiac region, and fundus of the stomach; its main trunk runs along the anterior edge of the lesser curvature, and the longest branch—the left branch of Latarjet—runs to the pyloroduodenal/pyloroantral region.
For the posterior vagal trunk, the cited sources only indicate that gastric innervation is carried out by branches of the anterior and posterior vagal trunks; specific branches of the posterior vagal trunk to the stomach are not provided in the sources.
Which lymph nodes act as first-tier nodes for the greater curvature of the stomach?
For the greater curvature of the stomach, the regional first-tier nodes are the left and right gastro-omental lymph nodes.
- Left and right gastro-omental lymph nodes (nodi lymphoidei gastroomentales sinistri et dextri) are located along the greater curvature of the stomach in small groups.
Lymph from the lesser curvature goes into the lesser omentum, and from the greater curvature along the gastro-omental vessels. Second-tier nodes (coeliaci) sit directly on the celiac trunk in a quantity of 1–3.
Class and exam questions
Where are the intraorgan lymphatic networks of the stomach located?
They are found in all four layers of the organ's wall: in the mucosa, submucosa, muscular, and serous layers, interconnecting via anastomoses.
What role do the celiac lymph nodes play?
Celiac lymph nodes (nodi lymphatici coeliaci) are the main regional second-tier nodes for the stomach, liver, duodenum, pancreas, and splenic hilum.
Which nerve structures innervate the stomach?
Innervation is carried out by branches of the anterior and posterior vagal trunks, as well as the celiac plexus and its derivatives (hepatic, splenic, superior mesenteric, superior and inferior gastric plexuses).
Why are 1st- and 2nd-tier nodes removed in gastric cancer?
This is necessary for the radical removal of tumor metastasis pathways, since it is these groups of nodes that collect lymph directly from the gastric zone.
What else to study on this topic
- Anatomical features of extraorgan vessels of the lesser curvature
- Topography of subpyloric and superior mesenteric lymph nodes
- Pathways of lymph drainage from celiac nodes into aortic and caval collectors
- Branching of the anterior and posterior vagal trunks on the gastric walls
- Interrelationship of the celiac plexus and gastric nerve plexuses
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