Extended application of sentinel node navigation surgery to gastric cancer

我们开发了术中内镜淋巴标测（IELM）用于识别早期胃癌（EGC）患者的前哨淋巴结。共有126例EGC患者接受了IELM。术中应用电子内镜将专利蓝（一种亲淋巴染料）注入肿瘤周围粘膜。一些淋巴结在手术后几分钟被染成蓝色。我们将染色的淋巴结命名为蓝结（BN），将包括染色的淋巴结和淋巴管的区域命名为淋巴盆。在IELM后，我们进行了淋巴盆解剖和术中病理学检查，最后进行了D2标准胃切除术。IELM成功119例（94%），灵敏度为87%（34/39），特异性为100%（80/80），准确性为96%（114/119）。5例假阴性包括术中诊断的4例肉眼转移和1例漏诊转移。34例患者中有33例（97%）仅在BN中检测到淋巴转移， ...更多信息 或流域中的BN和非BN，其中包括BN。这些结果表明，如果术中病理学未证实解剖盆中BN的淋巴转移，则在EGC中可以应用有限的淋巴结解剖和有限的胃切除术。我们对51例EGC患者采用袖状胃切除术（SGR），并将其术后生活质量（QOL）与61例接受传统Billroth I（B-I）重建的患者的QOL进行比较。SGR组患者进食量超过术前口服摄入量80%的发生率为80%，而B-I组为67%。SGR组的倾倒率为5%，显著低于B-I组的18%。SGR组胃内胆汁反流和内镜下黏膜发红的发生率（0%和46%）明显低于B-I组（41%和82%）。结果表明，基于IELM和盆状切除的局限性手术是可行的，有利于EGC患者术后生活质量的提高。术前<99m>在电子内镜下向肿瘤周围粘膜内注射~（13）Tc-植酸盐。术中使用γ-探头检测热结节。在浸润至粘膜下层的患者中，25/26例（96%）成功，其敏感性为80%（4/5），特异性为100%（20/20），准确性为96%（24/25）。但17例浸润深度超过粘膜下层的患者中有6例出现假阴性。直肠癌前哨淋巴结定位需要技术改进

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