Extended application of sentinel node navigation surgery to gastric cancer

前哨淋巴结导航手术在胃癌中的推广应用

• 批准号: 15390390
• 负责人: MIWA Koichi
• 金额: $ 8.51万
• 依托单位: Kanazawa University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 2003
• 资助国家: 日本
• 起止时间: 2003 至 2004
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-15390390/
• 关键词: Sentinel node; Early gastric cancer; Rectal cancer; Navigation surgery; Function-preserving radical surgery; 縮小手術; 胃癌; 食道癌

We developed the intraoperative endoscopic lymphatic mapping (IELM) for identifying sentinel lymph nodes of patients with early-stage gastric cancer (EGC). A total of 126 patients with EGC underwent the IELM. The patent blue (a lymphophilic dye) was intraoperatively injected into the surrounding mucosa of tumor by using electronic endoscopy. Some lymph nodes were stained blue several minutes after this procedure. We named a stained lymph node a blue node (BN) and an area including stained nodes and lymphatics a lymphatic basin. After IELM we performed lymphatic basin dissection with intraoperative pathology, and finally standard gastrectomy with D2. IELM succeeded in 119 patients (94%) with a good performance of 87% (34/39) in sensitivity, 100% (80/80) in specificity, and 96% (114/119) in accuracy. Five false negatives consisted of four gross metastases and one overlooked metastasis at intraoperative diagnosis. Lymphatic metastases in 33 of 34 (97%) patients were detected in BNs alone, … More or BNs and non-BNs in the basin, which included BNs. These results suggested that if lymphatic metastases in BNs in the dissected basin were not proven in the intraoperative pathology, limited nodal dissection and limited gastric resection could be applicable in EGC. We applied sleeve gastric resection (SGR) to 51 EGC patients and its postoperative quality of life (QOL) was compared with the QOL of 61 patients undergoing conventional Billroth I (B-I) reconstruction. The incidence of the patients who could eat more than 80% of preoperative oral intake in SGR group was high as 80% compared to 67% in B-I group. Dumpers in SGR group were 5% significantly fewer than 18% in B-I group. The incidences of intragastric bile reflux and mucosal redness by endoscopy in SGR group (0% and 46%) were significantly lower than those in B-I group (41% and 82%). These results suggested that limited surgery based on IELM and basin dissection was feasible and beneficial for the postoperative QOL in EGC patients.We also applied the sentinel node mapping to 43 rectal cancer patients by RI method. The ^<99m>Tc-phytate was preoperatively injected into the surrounding mucosa of tumor by using electronic endoscopy. The hot nodes were intraoperatively detected using γ-probe. In the patients with the invasion up to submucosa, RI-mapping succeeded in 25 of 26 patients (96%) with a good performance of 80% (4/5) in sensitivity, 100% (20/20) in specificity, and 96% (24/25) in accuracy. But six of 17 patients with the invasion deeper than submucosa showed false negative. Technical improvement should be needed in sentinel node mapping of rectal cancer Less

我们发展了术中内窥镜淋巴标测(IELM)来识别早期胃癌(EGC)患者的前哨淋巴结。共有126名EGC患者接受了IELM检查。术中使用电子内窥镜将专利蓝(一种亲淋巴染料)注入肿瘤周围粘膜。手术后几分钟，一些淋巴结被染成蓝色。我们将染色的淋巴结命名为蓝色结节(BN)，将含有染色的结节和淋巴管的区域命名为淋巴盆。IELM后，我们行术中病理淋巴盆地清扫，最后行D2标准胃切除术。IELM成功119例(94%)，敏感性为87%(34/39)，特异性为100%(80/80)，准确性为96%(114/119)。5个假阴性包括4个肉眼转移瘤和1个术中诊断时被忽略的转移瘤。在34名患者中，有33名(97%)仅在BNS中就发现了淋巴转移，…盆地中的更多或BN和非BN，其中包括BN。这些结果提示，如果术中病理不能证实盆内淋巴结有淋巴转移，EGC可以采用有限的淋巴结清扫和有限的胃切除。应用袖式胃切除术(SGR)对51例EGC患者进行了术后生活质量(QOL)测定，并与61例Billroth I(B-I)重建术后患者的生活质量进行了比较。术前摄食量80%以上者，SGR组高达80%，而B-I组为67%。SGR组的自卸率为5%，明显低于B-I组的18%。胃镜下胃内胆汁反流和粘膜红肿发生率(0%和46%)明显低于B-I组(41%和82%)。这些结果表明，基于IELM和盆腔清扫术的局限性手术是可行的，有利于改善EGC患者的术后生活质量。我们还应用RI法对43例直肠癌患者进行了前哨淋巴结标测。术前在电子内窥镜下将~(99)m&~(99m)Tc-植酸盐注入肿瘤周围粘膜。术中应用γ探头探查热结节。在累及黏膜下层的26例患者中，25例(96%)RI标测成功，敏感性为80%(4/5)，特异性为100%(20/20)，准确性为96%(24/25)。但17例侵犯深度大于粘膜下层的患者中有6例呈假阴性。直肠癌前哨淋巴结标测技术亟待改进

项目成果

胃癌リンパ区域郭清術

胃癌淋巴结清扫术

• 发表时间: 2003
• 期刊: 手術 57
• 作者: Hiromichi Kawaida;Koji Kono;Akihiro Takahashi;Hidemitsu Sugai;Kosaku Mimura;Naoto Miyagawa;Hideo Omata;Hiroshi Kumamoto;Akishi Ooi;Hideki Fujii;三輪晃一
• 通讯作者: 三輪晃一

Anti-metastatic effect of capecitabine on human colon cancer xenografts in nude mouse rectum

卡培他滨对人结肠癌裸鼠直肠移植瘤的抗转移作用

• 发表时间: 2004
• 期刊: International Journal of Cancer 112
• 作者: Ninomiya I

K Miwa, S Kinami, K Taniguchi, S Fushida, T Fujimura, A Nonomura: "Mapping sentinel nodes in patients with early-stage gastric carcinoma"British Journal of Surgery. 90・2. 178-182 (2003)

K Miwa、S Kinami、K Taniguchi、S Fushida、T Fujimura、A Nonomura：“绘制早期胃癌患者的前哨淋巴结”英国外科杂志 90・2（2003 年）。

太田 哲生, 三輪 晃一, 二宮 致, 藤村 隆, 西村 元一・他: "膵癌におけるセンチネルリンパ節navigation surgery"日本臨牀. 61・8. 366-370 (2003)

Tetsuo Ota、Koichi Miwa、Satoshi Ninomiya、Takashi Fujimura、Motoichi Nishimura 等：“胰腺癌前哨淋巴结导航手术”Nippon Clinical Trials 61・8 (2003)。

Sentinel lymph node navigation surgery for pancreatic head cancers

胰头癌的前哨淋巴结导航手术

• 发表时间: 2003
• 期刊: Oncology Reports 10
• 作者: Kousaku Mimura;Koji Kono;Mitsuhiko Hanawa;Fumihiko Mitsui;Hidemitsu Sugai;Naoto Miyagawa;Akishi Ooi;Hideki Fujii;三輪 晃一;Tetsuo Ohta
• 通讯作者: Tetsuo Ohta