An Ji Yeong, Min Jae Seok, Lee Young Joon, Jeong Sang Ho, Hur Hoon, Han Sang Uk, Hyung Woo Jin, Cho Gyu Seok, Jeong Gui Ae, Jeong Oh, Park Young Kyu, Jung Mi Ran, Park Ji Yeon, Kim Young Woo, Yoon Hong Man, Eom Bang Wool, Ryu Keun Won
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Republic of Korea.
Gastroenterol Res Pract. 2017;2017:1732571. doi: 10.1155/2017/1732571. Epub 2017 Jun 15.
We investigated the results of quality control study prior to phase III trial of sentinel lymph node navigation surgery (SNNS).
Data were reviewed from 108 patients enrolled in the feasibility study of laparoscopic sentinel basin dissection (SBD) in gastric cancer. Seven steps contain tracer injection at submucosa (step 1) and at four sites (step 2) by intraoperative esophagogastroduodenoscopy (EGD), leakage of tracer (step 3), injection within 3 minutes (step 4), identification of at least one sentinel basin (SB) (step 5), evaluation of sentinel basin nodes (SBNs) by frozen biopsy (step 6), and identification of at least five SBNs at back table and frozen sections (step 7).
Failure in step 7 ( = 23) was the most common followed by step 3 ( = 15) and step 6 ( = 13). We did not find any differences of clinicopathological factors between success and failure group in steps 1~6. In step 7, body mass index (BMI) was only the significant factor. The success rate was 97.1% in patients with BMI < 23 kg/m and 80.3% in those with BMI ≥ 23 kg/m ( = 0.028).
Lower BMI group showed higher success rate in step 7. Surgeons doing SNNS should be cautious when evaluating sufficient number of SBN in obese patients.
我们调查了前哨淋巴结导航手术（SNNS）III期试验前的质量控制研究结果。
回顾了108例参加胃癌腹腔镜前哨区域清扫（SBD）可行性研究患者的数据。七个步骤包括通过术中食管胃十二指肠镜检查（EGD）在黏膜下层（步骤1）和四个部位（步骤2）注射示踪剂、示踪剂渗漏（步骤3）、3分钟内注射（步骤4）、识别至少一个前哨区域（SB）（步骤5）、通过冷冻活检评估前哨区域淋巴结（SBNs）（步骤6）以及在手术台后部和冷冻切片时识别至少五个SBNs（步骤7）。
步骤7失败（n = 23）最为常见，其次是步骤3（n = 15）和步骤6（n = 13）。在步骤1至6中，我们未发现成功组和失败组之间临床病理因素存在任何差异。在步骤7中，体重指数（BMI）是唯一的显著因素。BMI < 23 kg/m²的患者成功率为97.1%，BMI≥23 kg/m²的患者成功率为80.3%（P = 0.028）。
较低BMI组在步骤7中显示出较高的成功率。进行SNNS的外科医生在评估肥胖患者足够数量的SBNs时应谨慎。
