Department of Surgery, University Vita-Salute San Raffaele, Via Olgettina, 60-20132, Milan, Italy.
Surg Endosc. 2010 Sep;24(9):2324-6. doi: 10.1007/s00464-010-0950-0. Epub 2010 Feb 26.
With increasing experience, sentinel node navigation has been applied even to gastric cancer. Sentinel lymph nodes are identified by injecting lymphatic tracer dye and radioisotope-labeled particles around a gastric tumor into the submucosa endoscopically. The aim of this video was to demonstrate the feasibility of laparoscopic sentinel node navigation (SLN) in gastric cancer.
A 71-year-old man with a diagnosis of gastric cancer was admitted to the authors' department. The preoperative workup demonstrated a uT1 node-negative gastric cancer. The patient was scheduled for laparoscopic distal gastrectomy with SLN. The day before surgery, the patient was submitted to endoscopy. During the procedure, the radiotracer (technetium-99) was injected at four points around the tumor. The operation was performed with the patient in the Lloyd-Davies position using four trocars. After opening of the gastrocolonic ligament, the patient underwent an intraoperative endoscopy, and blue dye (patent blue) was injected at four points around the tumor. The lymphatic basin was identified with the probe and the blue dye. The sentinel node then was identified. No pickup technique was used. A standard laparoscopic gastrectomy with intracorporeal anastomosis was concluded successfully. Through a supraumbilical incision, the specimen was extracted. The sentinel node was dissected at the bench table after the operation.
The pathologic report demonstrated a gastric carcinoma, namely, pT1, pN1 (Sentinel node (Sn), 1/36), G3 gastric cancer. Only the sentinel node was positive, containing a micrometastasis. The patient's postoperative course was uneventful.
Sentinel node navigation with a double tracer during laparoscopic gastrectomy for cancer is feasible. Nevertheless, it is mandatory to standardize the method of SLN identification to increase the diagnosis of lymph node metastases.
随着经验的增加，前哨淋巴结导航技术甚至已应用于胃癌。通过内镜将淋巴示踪染料和放射性同位素标记的颗粒注射到胃肿瘤周围的黏膜下层，以识别前哨淋巴结。本视频旨在演示腹腔镜下前哨淋巴结导航（SLN）在胃癌中的可行性。
一名 71 岁男性，诊断为胃癌，收入作者所在科室。术前检查示 uT1 淋巴结阴性胃癌。患者拟行腹腔镜远端胃切除术联合 SLN。手术前一天，患者接受了内镜检查。在操作过程中，将放射性示踪剂（锝-99）注射到肿瘤周围的四个点。手术在 Lloyd-Davies 体位下进行，使用四个 trocar。打开胃结肠韧带后，患者接受了术中内镜检查，并在肿瘤周围的四个点注射蓝色染料（专利蓝）。使用探头和蓝色染料识别淋巴管池。然后识别前哨淋巴结。未使用任何取检技术。成功完成了标准的腹腔镜胃切除术和腔内吻合术。通过脐上切口，提取标本。手术后在 bench table 上进行前哨淋巴结切除术。
病理报告显示为胃癌，即 pT1、pN1（前哨淋巴结（Sn），1/36）、G3 胃癌。仅前哨淋巴结阳性，含有微转移。患者术后恢复顺利。
在腹腔镜胃癌根治术中使用双示踪剂进行前哨淋巴结导航是可行的。然而，必须规范 SLN 识别方法，以增加对淋巴结转移的诊断。
