Development of novel minimally invasive surgery for solid tumors using sentinel node navigation

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The first possible sites of metastasis along the route of lymphatic drainage from the primary lesion are known as sentinel nodes (SNs) and these are detectable using injection of dyes or radioactive tracers. To develop individualized minimally invasive surgery for solid tumors without lymph node metastasis based on SN status, we have performed validation study of radio-guided SN mapping for more than 800 cases of solid tumors. From clinical data for these cases, an adequate indication of this methodology was determined. Optimal particle sizes in radio-guided method in each organ were also investigated. Performance and limitations of currently available laparoscopic gamma probes were analyzed and requirements for the gamma probes in the next generation were proposed. Quality of preoperative lymphoscintigrams to detect the number and distribution of sentinel node was significantly improved by modified technology of imaging data. Portable gamma camera to visualize SNs in operation theater was developed and evaluated in this study. Sensitivity of intra-operative evaluation of SN is crucial factor for successful and safe clinical application of SNNS. A Prototype of intra-operative semi-quantitative real time RT PCR to detect molecular metastasis was established. Now we are currently investigating novel local chemotherapy based on SN concept using special particle with anti-tumor reagent in animal model. These findings from this project would contribute a development of novel minimally invasive treatments for solid tumors.