Lymph node stations for gastrectomy
Reading File
Finding Sources
Searching Images
lymph node stations gastrectomy stomach JGCA classification diagram
Finding Sources
Searching the Web
JGCA lymph node stations gastrectomy D1 D2 dissection classification 2023
Reading File
Reading Web Page
https://pmc.ncbi.nlm.nih.gov/articles/PMC11036764
Loading Image
Here is a complete reference for lymph node stations in gastrectomy, based on the JGCA classification (2021/2025, 6th-7th edition guidelines) and Bailey & Love's Surgery.
JGCA Lymph Node Stations - Gastrectomy
Station Numbering and Anatomy
| Station | Location |
|---|---|
| 1 | Right paracardial |
| 2 | Left paracardial |
| 3a | Lesser curvature (left gastric artery branches) |
| 3b | Lesser curvature (right gastric artery branches) |
| 4sa | Short gastric vessels |
| 4sb | Left gastroepiploic vessels |
| 4d | Right gastroepiploic vessels |
| 5 | Suprapyloric (right gastric artery) |
| 6 | Infrapyloric (right gastroepiploic artery) |
| 7 | Left gastric artery |
| 8a | Common hepatic artery (anterosuperior) |
| 8p | Common hepatic artery (posterior) |
| 9 | Celiac axis |
| 10 | Splenic hilum |
| 11p | Proximal splenic artery |
| 11d | Distal splenic artery |
| 12a | Hepatoduodenal ligament (left, along hepatic artery) |
| 12b | Hepatoduodenal ligament (posterior, along bile duct) |
| 12p | Hepatoduodenal ligament (posterior, along portal vein) |
| 13 | Posterior surface of pancreatic head |
| 14v | Superior mesenteric vein |
| 15 | Middle colic vessels |
| 16a1 | Para-aortic (aortic hiatus) |
| 16a2 | Para-aortic (left renal vein level) |
| 16b1 | Para-aortic (left renal vein to inferior mesenteric artery) |
| 16b2 | Para-aortic (inferior mesenteric artery to aortic bifurcation) |
| 17 | Anterior pancreatic surface |
| 18 | Inferior pancreatic margin |
| 19 | Infradiaphragmatic |
| 20 | Esophageal hiatus |
D-Level Dissections by Gastrectomy Type (JGCA 2021/2025)
Total Gastrectomy
| Level | Stations |
|---|---|
| D1 | 1, 2, 3, 4sa, 4sb, 4d, 5, 6, 7 |
| D1+ | D1 + 8a, 9, 11p |
| D2 | D1 + 8a, 9, 10, 11p, 11d, 12a |
For tumors invading the esophagus, add Nos. 19, 20, 110 to D2.
Distal (Subtotal) Gastrectomy
| Level | Stations |
|---|---|
| D1 | 1, 3, 4sb, 4d, 5, 6, 7 |
| D1+ | D1 + 8a, 9 |
| D2 | D1 + 8a, 9, 11p, 12a |
Pylorus-Preserving Gastrectomy (PPG)
| Level | Stations |
|---|---|
| D1 | 1, 3, 4sb, 4d, 6, 7 |
| D1+ | D1 + 8a, 9 |
No D2 defined for PPG.
Proximal Gastrectomy
| Level | Stations |
|---|---|
| D1 | 1, 2, 3a, 4sa, 4sb, 7 |
| D1+ | D1 + 8a, 9, 11p |
| D2 | D1 + 8a, 9, 11p, 11d |
For tumors invading the esophagus, add Nos. 19, 20, 110 to D2.
Indications for Each D Level
| Indication | Level |
|---|---|
| cT1a (EGC, mucosal) | D1 sufficient |
| cT1N0 >1.5 cm or poorly differentiated | D1+ |
| cT1N+ or cT2-T4 (potentially curable) | D2 (standard) |
| cT2-T4, upper stomach, greater curvature | D2 + consider splenectomy (station 10) |
- D3 dissection (para-aortic, station 16) is no longer recommended - the JCOG 9501 trial showed no survival benefit and increased morbidity.
- Station 7 (left gastric artery) is included in D1 regardless of gastrectomy type - this was standardized since JGCA 2010.
Mediastinal Stations (Esophagogastric Junction Tumors)
When the tumor extends to the esophagus, additional mediastinal stations are dissected:
| Station | Location |
|---|---|
| 19 | Infradiaphragmatic |
| 20 | Esophageal hiatus |
| 110 | Lower thoracic paraesophageal |
| 111 | Diaphragmatic |
| 112 | Posterior mediastinal |
The diagram from Bailey & Love above shows the full mediastinal classification (stations 100-114) in the context of esophageal/esophagogastric surgery.
Key Points
- D2 is the standard for resectable cT2-T4 or node-positive gastric cancer per JGCA, ESMO, and most guidelines.
- Stations are numbered anatomically (not by tier) - D-level is defined per operation type, not by station number alone.
- Spleen-preserving D2 is preferred; splenectomy only added if the tumor directly involves the splenic hilum or upper greater curvature.
- The 2025 JGCA 7th edition guidelines maintain the same D1/D1+/D2 framework as the 6th edition with minor refinements.
Sources: JGCA 2021 guidelines, Optimal LN dissection review, JGCA 2025 7th edition, Bailey & Love's Surgery 28th ed.
This is a shared conversation. Sign in to Orris to start your own chat.