Li Zong-lin, Jiang Huai-wu, Song Min, Xu Liang, Xia Dong, Liu Qing
Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sichuan Medical University, Luzhou 646000, China.
Department of Gastrointestinal Surgery, the Second Affiliated Hospital of North Sichuan Medical College, Mianyang 621000, China.
J Zhejiang Univ Sci B. 2015 Nov;16(11):897-903. doi: 10.1631/jzus.B1500053.
To explore the feasibility and clinical value of secondary sentinel lymph node (SSLN) tracing technique in radical gastrectomy for advanced gastric cancer (AGC).
From January 2009 to June 2011, 247 patients who suffered from gastric angle cancer with metastasis in No. 3 group lymph nodes were divided randomly into groups A and B. Methylthioninium chloride was injected into the peripheral tissue of the metastatic No. 3 group lymph nodes of 138 patients in group A before tumor resections. SSLNs were traced and individual lymphadenectomies were carried out based on the biopsy results of the SSLNs. Standard D2 radical gastrectomies were carried out directly on 109 patients in group B. Postoperative follow-up and survival analysis were carried out for patients in both groups.
SSLNs were found in 114 (82.6%) patients in group A. Ninety of those patients (78.9%) demonstrated existing metastasis in SSLNs. According to Kaplan-Meier's method, the postoperative 3-year cumulative survival rates were 63.5% and 47.5%, and the median survival time were 40 and 36 months for the patients of groups A and B, respectively (P<0.05).
The SSLN tracing technique is feasible in radical gastrectomy for AGC. It gives surgeons important information about the terminal status of lymph node metastasis and provides some scientific basis for individual lymphadenectomy.
探讨晚期胃癌（AGC）根治性胃切除术中二次前哨淋巴结（SSLN）示踪技术的可行性及临床价值。
2009年1月至2011年6月，将247例胃角癌伴第3组淋巴结转移患者随机分为A、B两组。A组138例患者在肿瘤切除术前，将亚甲蓝注入第3组转移淋巴结的周围组织。根据SSLN的活检结果进行示踪并实施个体化淋巴结清扫。B组109例患者直接行标准D2根治性胃切除术。对两组患者进行术后随访及生存分析。
A组114例（82.6%）患者发现有SSLN。其中90例（78.9%）患者的SSLN存在转移。根据Kaplan-Meier法，A、B两组患者术后3年累积生存率分别为63.5%和47.5%，中位生存时间分别为40个月和36个月（P<0.05）。
SSLN示踪技术在AGC根治性胃切除术中可行。它为外科医生提供了有关淋巴结转移终末状态的重要信息，并为个体化淋巴结清扫提供了一定的科学依据。
