Lee Young-Joon, Ha Woo-Song, Park Soon-Tae, Choi Sang-Kyung, Hong Soon-Chan, Park Jung-Woo
Department of Surgery, Gyeongsang National University Hospital, Jinju, Gyeongsang South Province, Korea. yjlee@
J Laparoendosc Adv Surg Tech A. 2008 Jun;18(3):357-63. doi: 10.1089/lap.2007.0024.
Sentinel-node navigation surgery (SNNS) for breast cancer and melanoma has been accepted as a reasonable oncologic surgery worldwide. On the other hand, in gastric cancers that do metastasize well to the lymph node, the use of SNNS has been approached with care and performed in only limited cases. Some obstacles still have to be overcome, such as the shortcomings of SN tracers and the technical limitations of laparoscopic SN detection. The aims of this study were to determine whether laparoscopic SNNS is possible, and which biopsy method is more suitable for SN tracers, in gastric cancer, preoperatively diagnosed as < or =T2 and with < or =4-cm-sized lesions.
Between January 2005 and October 2006, 92 consecutive patients that underwent LSNNS, using a combined indocyanine green and (99m)Tc-labeled tin colloid technique, were prospectively studied. SNs were laparoscopically removed by using two biopsy methods: a basin dissection and pick-up method, with the results of these two SN biopsy methods then compared with the final diagnosis obtained from a permanent section.
With the pick-up method, SNs were identified in 23 of 42 patients (54.8%); however, with basin dissection, the detection rate was 96% (48 of 50 patients). The average number of SNs detected by the two methods were 2.1 (range, 0-4) and 3.5 (range, 1-7), respectively. The sensitivities of the two methods were 66% (4/6) and 85.7% (12/14), with specificities of 100% (17/17) and 100% (34/34), respectively.
In gastric cancer, it was possible to perform LSNNS. At this moment, we believe the laparoscopic basin dissection technique with a dual-tracer injection, followed by SN detection on the back table, will be a reasonable procedure for gastric cancer, owing to the shortcomings related to the dye and radioisotope, the so-called "stained lymphatic duct only" and "shine-through phenomenon."
前哨淋巴结导航手术（SNNS）用于乳腺癌和黑色素瘤已在全球范围内被视为一种合理的肿瘤手术。另一方面，在淋巴结转移良好的胃癌中，SNNS的应用一直较为谨慎，仅在有限的病例中进行。仍有一些障碍需要克服，例如前哨淋巴结示踪剂的缺点以及腹腔镜前哨淋巴结检测的技术限制。本研究的目的是确定在术前诊断为T2期及以下且肿瘤大小为4厘米及以下的胃癌中，腹腔镜SNNS是否可行，以及哪种活检方法更适合前哨淋巴结示踪剂。
2005年1月至2006年10月，对92例连续接受腹腔镜前哨淋巴结导航手术（LSNNS）的患者进行前瞻性研究，采用吲哚菁绿和（99m）锝标记的锡胶体联合技术。通过两种活检方法腹腔镜切除前哨淋巴结：盆扫和拾取法，然后将这两种前哨淋巴结活检方法的结果与从永久切片获得的最终诊断结果进行比较。
采用拾取法，42例患者中有23例（54.8%）发现前哨淋巴结；然而，采用盆扫法时，检出率为96%（50例患者中的48例）。两种方法检测到的前哨淋巴结平均数量分别为2.1个（范围0 - 4个）和3.5个（范围1 - 7个）。两种方法的敏感性分别为66%（4/6）和85.7%（12/14），特异性分别为100%（17/17）和100%（34/34）。
在胃癌中，进行腹腔镜前哨淋巴结导航手术是可行的。目前，我们认为采用双示踪剂注射的腹腔镜盆扫技术，随后在手术台上检测前哨淋巴结，由于与染料和放射性同位素相关的缺点，即所谓的“仅染色淋巴管”和“穿透现象”，对于胃癌将是一种合理的手术方法。
