Ohdaira Hironori, Yoshida Masashi, Okada Shinya, Tsutsui Nobuhiro, Kitajima Masaki, Suzuki Yutaka
Departments of Surgery, International University of Health and Welfare Hospital, Japan.
Department of Pathology, International University of Health and Welfare Hospital, Japan.
Ann Med Surg (Lond). 2017 Jun 27;20:61-65. doi: 10.1016/j.amsu.2017.06.019. eCollection 2017 Aug.
The present study describes the retrospective feasibility study of ICG fluorescence SN mapping in back-table for early gastric cancer using PINPOINT.
SN mapping were performed as following; the day before surgery, 0.5 ml ICG was injected endoscopically in four quadrants of the submucosa surrounding the gastric cancer using an endoscopic puncture. Intraoperatively, the gastrocolic ligament was divided to visualize all possible directions of lymphatic flow from the stomach. PINPOINT (NOVADAQ, Canada) was used to illuminate regional lymph nodes from the serosal side. Positive staining was confirmed by at least 3 surgeons and an endoscopist during surgery (Figure 1). Lymph node dissection and gastrectomy were performed according to the criteria of gastric cancer treatment guidelines of JGCA.
All 6 patients had gastrectomy with laparoscopic approach. ICG positive lymphatic flow and lymph nodes were able to be observed in all the patients. Final pathological diagnosis was all StageI and curative resection. All the patients had ICG positive lymphatic area in left gastric artery (LGA) area. Two patients with tumor located in L area had ICG positive flow to right gastroepipoloic artery (RGEA) area. The mean of ICG positive lymph nodes was 8.6. One patient had a metastatic lymph node in station No.4, which was positive for ICG.
Our method made identification of ICG positive lymph nodes easy in SN mapping in back-table under room light. Although further accumulation and analysis are necessary, we may be able to apply this method for intraoperative SN mapping of laparoscopic gastric cancer surgey.
本研究描述了使用PINPOINT对早期胃癌进行术中荧光示踪剂（ICG）前哨淋巴结（SN）定位的回顾性可行性研究。
SN定位按以下步骤进行；手术前一天，通过内镜穿刺在胃癌周围黏膜下层的四个象限内镜注射0.5ml ICG。术中，切开胃结肠韧带以观察胃淋巴引流的所有可能方向。使用PINPOINT（加拿大NOVADAQ公司）从浆膜侧照亮区域淋巴结。术中至少3名外科医生和1名内镜医生确认染色阳性（图1）。根据日本胃癌治疗指南标准进行淋巴结清扫和胃切除术。
所有6例患者均采用腹腔镜方法行胃切除术。所有患者均能观察到ICG阳性淋巴引流和淋巴结。最终病理诊断均为Ⅰ期且为根治性切除。所有患者在胃左动脉（LGA）区域均有ICG阳性淋巴区域。2例肿瘤位于L区的患者有ICG阳性引流至胃网膜右动脉（RGEA）区域。ICG阳性淋巴结的平均数为8.6。1例患者在第4组有1个转移淋巴结，ICG呈阳性。
我们的方法使在室内光线下的术中SN定位中识别ICG阳性淋巴结变得容易。尽管需要进一步积累和分析，但我们或许能够将此方法应用于腹腔镜胃癌手术的术中SN定位。
