Extended application of sentinel node navigation surgery to gastric cancer

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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