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

吲哚菁绿红外线腹腔镜系统SNNS治疗胃癌的研究

基本信息

批准号：
16591356
负责人：
NIMURA Hiroshi
金额：
$ 2.63万
依托单位：
Jikei University School of Medicine
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2004
资助国家：
日本
起止时间：
2004 至 2007
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-16591356/
关键词：
sentinel node gastric cancer laparoscopic surgery infrared rav observation ICG

项目摘要

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.

前言：通过吲哚青绿(ICG)红外线(IR)观察，阐明前哨淋巴结导航手术(SNNS)在胃癌治疗中的临床应用及前景。方法选择211例胃癌患者，分别行开腹(n=120)和腹腔镜(n=91)胃切除术。评价指标包括：(1)IR观察前哨淋巴结(SN)的识别率和敏感度；(2)术中淋巴结(LN)转移的检出率，与淋巴清扫法(LBD)比较(n=54)；(3)HE染色和细胞角蛋白(CK)免疫组化染色对LN转移诊断的准确性(n=130)。结果1)对于开腹手术患者，SN识别率为99%(119/120)，敏感度为96%(22/23)。对于腹腔镜手术患者，SN识别率为100%(91/91)，敏感性为100%(12/12)。2)Pick法检出8例LN转移，LBD法检出16例LN转移。其中LN转移的术中诊断准确率为25%(2/8)比81%(13/16)，术后石蜡HE染色诊断准确率为0%(0/8)比6%(1/16)，CK染色诊断准确率为38%(3/8)比13%(2/16)。3)HE染色和CK染色的病例数和淋巴结转移数分别为16/130例(12%)和31/130例(24%)。HE染色判定pN0者15例，CK染色判定N(+)者15例。无假阴性病例。27例转移性LN经HE染色和N(+)CK染色均为pN0。转移类型：单细胞型；5个结节，丛集型；16个结节，微转移型；6个结节。结论SNNS联合IR治疗胃癌不仅适用于开腹胃切除术，也适用于腹腔镜手术。LBD是准确识别SN和术中诊断胃癌LN转移所必需的。