Santos F A V, Drummond-Lage A P, Rodrigues M A, Cabral M A, Pedrosa M S, Braga H, Wainstein A J A
Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Instituto de Pós Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brasil.
Braz J Med Biol Res. 2016 Jul 11;49(8). doi: 10.1590/1414-431X20165341.
Lymph node metastases are an independent prognosis factor in gastric carcinoma (GC) patients. Radical lymphadenectomy can improve survival but it can also increase surgical morbidity. As a principle, sentinel node (SN) navigation surgery can avoid unnecessary lymphadenectomy without compromising prognosis. In this pilot study, 24 patients with untreated GC were initially screened for SN navigation surgery, of which 12 were eligible. Five patients had T2 tumors, 5 had T3 tumors and 2 had T1 tumors. In 33% of cases, tumor diameter was greater than 5.0 cm. Three hundred and eighty-seven lymph nodes were excised with a median of 32.3 per patient. The SN navigation surgery was feasible in all patients, with a median of 4.5 SNs per patient. The detection success rate was 100%. All the SNs were located in N1 and N2 nodal level. In 70.9% of cases, the SNs were located at lymphatic chains 6 and 7. The SN sensitivity for nodal staging was 91.6%, with 8.3% of false negative. In 4 patients who were initially staged as N0, the SNs were submitted to multisection analyses and immunohistochemistry, confirming the N0 stage, without micrometastases. In one case initially staged as negative for nodal metastases based on SN analyses, metastases in lymph nodes other than SN were found, resulting in a 20% skip metastases incidence. This surgery is a reproducible procedure with 100% detection rate of SN. Tumor size, GC location and obesity were factors that imposed some limitations regarding SN identification. Results from nodal multisection histology and immunohistochemistry analysis did not change initial nodal staging.
淋巴结转移是胃癌（GC）患者的独立预后因素。根治性淋巴结清扫术可提高生存率，但也会增加手术并发症。原则上，前哨淋巴结（SN）导航手术可避免不必要的淋巴结清扫，同时不影响预后。在这项前瞻性研究中，对24例未经治疗的GC患者进行了SN导航手术的初步筛查，其中12例符合条件。5例患者为T2肿瘤，5例为T3肿瘤，2例为T1肿瘤。33%的病例中肿瘤直径大于5.0 cm。共切除387枚淋巴结，每位患者平均切除32.3枚。SN导航手术在所有患者中均可行，每位患者平均有4.5枚SN。检测成功率为100%。所有SN均位于N1和N2淋巴结水平。70.9%的病例中，SN位于第6和第7组淋巴结链。SN对淋巴结分期的敏感度为91.6%，假阴性率为8.3%。在4例最初分期为N0的患者中，对SN进行了多切片分析和免疫组化检查，证实为N0期，无微转移。1例最初根据SN分析分期为淋巴结转移阴性的病例，在非SN的淋巴结中发现了转移，跳跃转移发生率为20%。该手术是一种可重复的操作，SN检测率为100%。肿瘤大小、GC位置和肥胖是影响SN识别的限制因素。淋巴结多切片组织学和免疫组化分析结果未改变初始淋巴结分期。
