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

从原发病灶沿淋巴引流路径沿着的第一个可能的转移部位被称为前哨淋巴结（SN），并且这些可以通过注射染料或放射性示踪剂来检测。为根据SN状态开展针对无淋巴结转移实体瘤的个体化微创手术，我们对800余例实体瘤进行了放射引导SN标测的验证性研究。根据这些病例的临床数据，确定了该方法的充分适应症。还研究了每个器官中放射引导方法的最佳颗粒尺寸。分析了目前可用的腹腔镜伽马探头的性能和局限性，并提出了下一代伽马探头的要求。通过改进影像学数据技术，术前淋巴结造影检测前哨淋巴结数量和分布的质量显著提高。本研究开发并评估了便携式伽玛相机在手术室中可视化SN。术中对SN评估的敏感性是SNNS临床应用成功和安全的关键因素。建立了术中半定量真实的时间RT PCR检测肿瘤转移的方法。目前，我们正在研究基于SN概念的新型局部化疗，使用特殊颗粒与抗肿瘤试剂在动物模型中。该项目的这些发现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.