Validity of modified gastrectomy combined with sentinel node navigation surgery for early gastric cancer
Validity of modified gastrectomy combined with sentinel node navigation surgery for early gastric cancer
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DOI：
10.1007/s10120-007-0419-6
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发表时间：
2007-06-01
期刊：
影响因子：
7.4
通讯作者：
Yanaga, Katsuhiko
中科院分区：
文献类型：
--
作者：
Ohdaira, Hironori;Nimura, Hiroshi;Yanaga, Katsuhiko
背景资料。根据前哨淋巴结导航手术(SNNS)的结果，采用红外线电子内窥镜(IREE)加吲哚青绿(ICG)染色，探讨改良胃切除术治疗早期胃癌的临床有效性。161例fT1N0胃癌患者纳入研究。ICG(0.5ml，5 mg/ml)经鼻内窥镜下注入癌旁粘膜下层的四个象限。注射后20min，在腹膜周围及周围脂肪组织观察到ICG染色的前哨淋巴结(SN)。结果：采用IREE从浆膜侧对区域淋巴结进行显示。第2组有52例(32%)被诊断为SNS。SNS最常见的位置是7号站，分别位于胃的上、中、下三分之一。2例患者淋巴结转移阳性。其中1例为胃中1/3癌，在3号、4SB、4d、7号和11p号站有淋巴结转移，在3号和7号站有淋巴结转移(均为SNS)。另1例为胃下1/3癌，分别于第1、3、4、6天出现淋巴结转移，第4天(SN)有转移性淋巴结。本研究中未观察到跳跃式转移，转移性淋巴结经D1+Alpha手术判断为已清扫。对于T1N0期胃癌，改良胃切除(D1+α清扫)联合SNNS是合适的，但对于第2组淋巴结被判定为SNS的患者，应进一步行SNNS检出的淋巴盆清扫，以确定无淋巴结转移。
Background. The present study examined the clinical validity of modified gastrectomy for early gastric cancer, in terms of the results of sentinel node navigation surgery ( SNNS), using infrared ray electronic endoscopy ( IREE) plus indocyanine green ( ICG) staining.Methods. One-hundred and sixty-one patients with fT1N0 gastric cancer were enrolled in the study. ICG ( 0.5 ml, 5 mg/ml) was injected endoscopically into four quadrants of the submucosa surrounding the cancer. Twenty minutes after the injection, sentinel lymph nodes ( SNs) stained with ICG were observed intraperitoneally around the serosa and surrounding fat tissue. IREE was used to illuminate regional lymph nodes from the serosal side.Results. Group 2 lymph nodes were judged as SNs in 52 patients ( 32%). The most common locations of the SNs were stations No. 7 in each of the upper-, middle-, and lower- thirds of the stomach. In two patients, lymph node metastasis was positive. One of these patients, with cancer in the middle one-third of the stomach, had SNs in stations No. 3, 4sb, 4d, 7, and No. 11p, and had metastatic lymph nodes in No. 3 and No. 7 ( all SNs). The other patient, with cancer in the lower one-third of the stomach, had SNs in No. 1, 3, 4d, and 6, and had a metastatic lymph node in No. 4d ( SN). Skip metastasis was not observed in this study, and metastatic lymph nodes were judged to have been dissected by the D1+alpha procedure.Conclusion. For T1N0 gastric cancer, modified gastrectomy ( D1+ alpha dissection) combined with SNNS is suitable; however, for those whose Group 2 lymph nodes are judged to be SNs, additional dissection of lymphatic basins detected by SNNS should be performed to confirm the absence of lymph node metastasis.