Sentinel Node Mapping For Gastric Cancer Research Articles

Potential for local resection with sentinel node basin dissection for early gastric cancer based on the distribution of primary sites.

Based on the sentinel node (SN) concept, function-preserving surgery with SN basin dissection (SNBD) can be performed for SN-negative early gastric cancers. Particularly, a resection area can be minimized when the SN basin and primary site are closely localized. The aim of this study was to compare probabilities of being candidates for local resection with SNBD based on tumor location among patients with early gastric cancer. We retrospectively analyzed 358 patients who underwent surgery with SN mapping for gastric cancer in our institution from November 1999 to April 2014. The proportion of patients who had a localized single basin and the distributions of the SN basins and primary sites were investigated. Patients with single basin drainage excluding remote sentinel node basin were considered as candidates for local resection with SNBD. Of the 358 patients, 191 (53%) patients were considered eligible for local resection with SNBD. Patients with tumors located in the upper third of the stomach were more likely candidates for local resection than those with tumors in other locations (upper third, 68%; middle third, 50%; and lower third, 51%), whereas patients with tumors located in the anterior wall were less likely candidates than those with tumors other locations (anterior wall, 31%; posterior wall, 58%; greater curvature, 55%; and lesser curvature, 57%). We found that > 50% of the patients indicated for SN navigation surgery, particularly those with tumors in the upper third of the stomach, potentially could undergo partial resection with SNBD.

P-0054 Carbon Nanoparticles Mapping Sentinel Node in Patients with T1-3 Gastric Cancer

IntroductionThe sentinel node (SN) was proposed to predict metastases status of lymph nodes for the purpose of the limited resection in surgical treatment of gastric cancers. The possible usefulness of SN mapping for gastric cancer was evaluated in this study for the new mapping trace of carbon nanoparticles and the distribution of SN was analyzed. MethodsFifty patients of gastric cancer were injected with 1 ml of carbon nanoparticles solution subserosally of the gastric wall around the primary tumor site during surgery. The first stained lymph node was defined as the SN. The lymph node metastasis and the tumor staging were confirmed by histopathological and/or immunohistochemical examination. ResultsIn all of the 50 (100%) patients the SN was detected from 5 to 40 seconds after the tracer injection. The mean number of the SN was 1.28±0.64 (range 1 to 4). The accuracy and sensitivity to predict lymph node metastases by SN histopathological examination was 90.0% and 77.3% in all patients. For 26 T1 patients, it was 87.5% and 96.2%, respectively. False negativity occurred in 5 (8.7%) patients. The SN detection rate of number 3 lymph node was 83.3%, 100.0%, and 60.0% respectively, in the upper, middle, and lower third gastric cancer. ConclusionCarbon nanoparticles mapping SN is a feasible approach to predict lymph node metastatic status during the surgical treatment of gastric cancer, especially in patients with T1-stage gastric cancer. The number 3 lymph node was the most detected SN.

NOTES: The question for minimal resection and sentinel node in early gastric cancer

Surgical therapy for gastric cancer involves both removal of the cancer lesion and complete lymph node dissection. Natural orifice transluminal endoscopic surgery (NOTES) is considered to represent the next revolution in surgery. Many surgeons and endoscopists believe that NOTES may be a superior alternative for early gastric cancer treatment. Sentinel node (SN) navigation surgery for gastric cancer: Single institution results of SN mapping for early gastric cancer are increasingly being considered acceptable. Furthermore, a major large-scale clinical trial of SN mapping for gastric cancer has recently been completed by The Japan Society of SN Navigation Surgery study group. They reported false negative rate of 7.0% while the sensitivity of metastasis detection based on SN status was 93%. Combination of SN biopsy and NOTES: This concept was first described by Cahill et al who proved the feasibility of lymphatic mapping and SN biopsy by NOTES. Lymphatic channel filling was immediately observable via the intraperitoneal optics. Partial resection of the stomach by hybrid NOTES: Several centers have already reported gastrectomy assisted by NOTES using the transvaginal route. However, the main problem of full-thickness resection of gastric wall remains endoscopic gastric closure. Establishing an endoscopic suturing method would be an important step toward expanding potential indications. NOTES is met with both enthusiasm and skepticism but will gain its own place as human creativity eventually provides solutions to its technical limitations. In the near future, NOTES can evolve the capacity to complement the existing armamentarium for gastric cancer surgery.