Laparoscopy-assisted Proximal Gastrectomy with Sentinel Node Mapping for Early Gastric Cancer
Laparoscopy-assisted Proximal Gastrectomy with Sentinel Node Mapping for Early Gastric Cancer
复制标题
腹腔镜辅助近端胃切除术及前哨淋巴结定位治疗早期胃癌
作者：
H. Takeuchi;T. Oyama;S. Kamiya;R. Nakamura;Tsunehiro Takahashi;N. Wada;Y. Saikawa;Y. Kitagawa
背景由于某些技术问题，例如治愈性、安全性和术后患者生活质量的保持，腹腔镜辅助近端胃切除术（LAPG）仍然是一种相对不常见的手术。本研究的目的是评估新开发的 LAPG 手术治疗早期近端胃癌的可行性。方法我们连续入组 37 例术前诊断为胃上三分之一 cT1N0M0 原发性胃癌且原发肿瘤直径小于 4 cm 的患者。尝试了腹腔镜辅助近端胃切除术、前哨淋巴结 (SN) 标测、圆形吻合器食管胃吻合术和经口放置砧座。结果 36 名患者完成了 LAPG 手术。 1例患者因术中检测到1例SN，经术中病理诊断为转移阳性，转为腹腔镜辅助全胃切除术。所有患者均未出现严重的术后并发症。仅1例患者（3%）术后即刻出现轻度反流症状，内镜下胃食管反流病洛杉矶分类为B级；然而，质子泵抑制剂可以很好地控制症状。我们的 37 名患者（100%）成功检测到前哨淋巴结。每例解剖淋巴结和识别 SN 的平均数量分别为 29.7 和 5.8。基于SN状态预测淋巴结转移（包括孤立的肿瘤细胞）的敏感性和诊断准确性分别为100%（3/3）和100%（37/37）。所有患者在中位随访 26 个月的时间内均未出现复发。结论这项研究表明，我们的新型 LAPG 方法具有治愈性，并且代表了一种可行的微创手术方法，对于患有上三分之一早期胃癌的患者来说，发病率和术后反流性食管炎最小。
BackgroundLaparoscopy-assisted proximal gastrectomy (LAPG) remains a relatively uncommon procedure because of certain technical issues, such as curability, safety, and retention of postoperative patients’ quality of life. The aim of the present study was to evaluate the feasibility of a newly developed LAPG procedure for early-stage proximal gastric cancer.MethodsWe enrolled 37 consecutive patients who were preoperatively diagnosed with cT1N0M0 primary gastric cancer in the upper third of the stomach with the primary tumor diameter less than 4 cm. Laparoscopy-assisted proximal gastrectomy with sentinel node (SN) mapping and esophagogastric anastomosis with a circular stapler and transoral placement of the anvil was attempted.ResultsThe LAPG procedure was completed in 36 patients. It was converted to laparoscopy-assisted total gastrectomy in one patient because one SN detected intraoperatively was positive for metastasis by intraoperative pathological diagnosis. There were no severe postoperative complications in any patient. Only one patient (3%) complained of mild reflux symptoms immediately after operation, which were graded endoscopically as B by the Los Angeles Classification of gastroesophageal reflux disease; however, the symptoms were controlled well by a proton-pump inhibitor. Sentinel nodes were detected successfully in 37 (100%) of our patients. The mean number of dissected lymph nodes and identified SNs per case was 29.7 and 5.8, respectively. The sensitivity of prediction of nodal metastasis (including isolated tumor cells) and diagnostic accuracy based on SN status were 100% (3/3) and 100% (37/37), respectively. All patients have been free from recurrence for a median follow-up period of 26 months.ConclusionsThis study reveals that our novel LAPG approach is curative and represents a feasible minimally invasive surgical procedure with minimal morbidity and postoperative reflux esophagitis in patients with upper-third early-stage gastric cancer.
影响因子：
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作者：
D. Morton;Wenger Dr;J. Wong;J. Economou;L. Cagle;Storm Fk;L. Foshag;A. Cochran
通讯作者：
D. Morton;Wenger Dr;J. Wong;J. Economou;L. Cagle;Storm Fk;L. Foshag;A. Cochran