Study of SNNS by the Infrared Ray Laparoscopy System with Indocyanine green for gastric cancer

点击翻译按钮获取中文摘要

Introduction To clarify the clinical usefulness and the future of sentinel node navigation surgery (SNNS) by infrared ray (IR) observation using indocyanine green (ICG) for gastric cancer. Methods A total of 211 patients with gastric cancer who underwent open (n=120) or laparoscopic (n=91) gastrectomy were studied. Evaluated parameters consisted of 1) sentinel node (SN) identification rate and sensitivity of SNNS with IR observation (all patients), 2) The intraoperative detection rates of the lymph node (LN) metastasis, between pick up method (n=54) and lymphatic basin dissection (LBD) method (n=87), 3) Diagnostic accuracy of LN metastasis by HE stain and cytokeratin (CK) immunohistochemical stain (n=130). Results 1) For laparotomy patients, SN identification rate was 99% (119/120), and sensitivity was 96% (22/23). For laparoscopic surgery patients, SN identification rate was 100% (91/91), and sensitivity was 100% (12/12). 2) LN metastasis was present in eight patients by pick up method, and 16 patients by LBD method. Of these, intraoperative diagnostic accuracy of LN metastasis was 25% (2/8) vs. 81% (13/16), postoperative metastasis diagnostic rate by paraffin HE stain was 0% (0/8) vs. 6% (1/16), and postoperative metastasis diagnostic rate by CK stain was 38% (3/8) vs. 13% (2/16). 3) The number of patients and LN metastasis by HE stain vs. CK stain was 16/130 patients (12%) vs. 31/130 patients (24%), respectively. Fifteen patients were judged pN0 by HE stain and N(+) by CK stain. There were no false negative patients. Twenty-seven metastatic LN were pN0 by HE stain and N(+) CK stain. Metastasis type : single cell type ; 5 nodes, cluster type ; 16 nodes, micro metastasis type ; 6 nodes. Conclusion SNNS with IR for gastric cancer is clinically useful not only for open gastrectomy but also for laparoscopic surgery. LBD is required for acurrete SN identification and intraoperative diagnosis of LN metastasis for gastric cancer.