Gastrointestinal Cancer Center, Soonchunhyang University Hospital, Seoul, Korea.
Endoscopy. 2012 Oct;44(10):953-6. doi: 10.1055/s-0032-1310162. Epub 2012 Sep 17.
We combined endoscopic submucosal dissection (ESD) and sentinel node navigation surgery with the purpose of achieving complete resection of early gastric cancer while preserving the organ and assessing pathological nodal status. A total of 13 patients with cT1( ≤ 3 cm)N0 early gastric cancer underwent combined ESD and sentinel node navigation surgery (ESN) at a single tertiary referral center. Sentinel node navigation surgery using indocyanine green was performed during ESD and all suspected sentinel nodes were removed laparoscopically and examined intraoperatively. ESN was converted to gastrectomy with D2 dissection if there was evidence of metastasis on frozen section. ESN was completed in 12 patients and in 1 patient was converted to gastrectomy after sentinel node navigation surgery. En bloc tumor resection was achieved in all cases. Two patients underwent additional gastrectomy because they had tumor-positive vertical margins. In all cases ESN was conducted without intraoperative or postoperative adverse events. ESN is a feasible minimally invasive procedure that allows en bloc tumor resection to be achieved while assessing the pathological status of the lymph nodes.
我们将内镜黏膜下剥离术（ESD）和前哨淋巴结导航手术相结合，旨在在保留器官的同时实现早期胃癌的完全切除，并评估病理淋巴结状态。在一家三级转诊中心，共有 13 名 cT1（≤3cm）N0 早期胃癌患者接受了联合 ESD 和前哨淋巴结导航手术（ESN）。在 ESD 期间使用吲哚菁绿进行前哨淋巴结导航手术，并通过腹腔镜切除所有可疑前哨淋巴结并在术中检查。如果冷冻切片有转移证据，则将 ESN 转换为 D2 解剖的胃切除术。12 例患者完成了 ESN，1 例患者在进行前哨淋巴结导航手术后转为胃切除术。所有病例均实现了整块肿瘤切除。由于 2 例患者存在肿瘤阳性垂直切缘，因此进行了额外的胃切除术。在所有情况下，ESN 均无术中或术后不良事件。ESN 是一种可行的微创程序，可在评估淋巴结病理状态的同时实现整块肿瘤切除。
