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

目的探讨吲哚菁绿（ICG）对胃癌前哨淋巴结导航手术（SNNS）的红外（IR）观察的临床应用价值和前景。方法对211例胃癌患者行开放胃切除术（120例）和腹腔镜胃切除术（91例）进行回顾性分析。评估参数包括：1)红外观察前哨淋巴结（SN）的检出率及SNNS的敏感性（所有患者）；2)术中淋巴结（LN）转移的检出率，取材法（n=54）和淋巴池清扫法（n=87）； 3) HE染色和细胞角蛋白（CK）免疫组化染色对淋巴结转移的诊断准确性（n=130）。结果1)剖腹手术患者SN识别率为99%(119/120)，敏感性为96%（22/23）。腹腔镜手术患者SN识别率为100%(91/91)，敏感性为100%（12/12）。2)拾起法8例出现淋巴结转移，LBD法16例。其中术中对淋巴结转移的诊断准确率为25%（2/8）对81%(13/16)，术后石蜡HE染色对淋巴结转移的诊断率为0%（0/8）对6% (1/16)，CK染色对淋巴结转移的诊断率为38%（3/8）对13%（2/16）。3) HE染色与CK染色分别为16/130例（12%）和31/130例（24%）。15例患者经HE染色判断为pno， CK染色判断为N（+）。无假阴性患者。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个节点，集群型；16个淋巴结，微转移型；6节点。结论SNNS联合IR治疗胃癌不仅适用于开放式胃切除术，也适用于腹腔镜手术。对于胃癌淋巴结转移的准确鉴别和术中诊断，LBD是必需的。

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.