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

第一个可能的转移部位是前哨淋巴结（SNs），可以通过注射染料或放射性示踪剂检测到。为了开发基于SN状态的无淋巴结转移实体瘤个体化微创手术，我们对800多例实体瘤进行了放射引导下SN定位的验证研究。从这些病例的临床数据中，确定了这种方法的充分适应症。并对各脏器的最佳粒径进行了研究。分析了现有腹腔镜伽玛探头的性能和局限性，提出了对下一代伽玛探头的要求。通过改进成像数据技术，术前淋巴显像检测前哨淋巴结数量和分布的质量显著提高。本研究开发便携式伽玛相机，用于观察手术室内的SNs。术中评价SNNS的敏感性是SNNS临床成功、安全应用的关键因素。建立了术中半定量实时RT - PCR检测分子转移的原型。目前我们正在动物模型上研究基于SN概念的新型局部化疗，使用特殊颗粒配合抗肿瘤试剂。本项目的研究结果将有助于开发新的实体瘤微创治疗方法。

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.