Natsugoe Shoji, Arigami Takaaki, Uenosono Yoshikazu, Yanagita Shigehiro
Department of Digestive Surgery, Breast and Thyroid Surgery Field of Oncology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan.
Molecular Frontier Surgery Course of Advanced Therapeutics Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan.
Ann Gastroenterol Surg. 2017 Aug 31;1(3):180-185. doi: 10.1002/ags3.12027. eCollection 2017 Sep.
Recent prospective multicenter trials have demonstrated the clinical safety and efficacy of sentinel node navigation surgery (SNNS) in patients with early gastric cancer. Further, development of an intraoperative imaging system and an indocyanine green fluorescence imaging approach has been attracting attention as a novel tool for detection of the sentinel node (SN). The greatest advantage of an in vivo imaging system is that it visualizes SN and afferent lymphatic vessels from the primary tumor site more clearly than the conventional dye approach. Besides visualization of the SN, it is also essential to accurately assess the presence or absence of lymph node metastasis in the intraoperative management of SNNS. However, the clinical significance of lymph node micrometastasis (LNM) in patients with gastric cancer remains controversial. Reverse transcription-polymerase chain reaction (RT-PCR) is one of the representative assays used to identify LNM. A rapid RT-PCR assay that completes the detection of LNM within approximately 40 minutes has recently been produced and applied in the clinical management of SNNS. From the viewpoint of surgical methods, modified laparoscopic and endoscopic cooperative surgery with non-exposed approaches has recently been highlighted as a promising technique to prevent tumor dissemination caused by surgical procedures, and is likely to be clinically applied to SNNS in the future. When carrying out SNNS as a minimally invasive surgery, it is important to consider the balance between post-surgical quality of life and curability. Future prospective studies on SNNS will greatly contribute to furthering its establishment as a beneficial procedure for patients with early gastric cancer.
近期的前瞻性多中心试验已证明前哨淋巴结导航手术（SNNS）在早期胃癌患者中的临床安全性和有效性。此外，术中成像系统和吲哚菁绿荧光成像方法的开发作为检测前哨淋巴结（SN）的一种新工具已引起关注。体内成像系统的最大优势在于，与传统染料法相比，它能更清晰地显示来自原发肿瘤部位的SN和输入淋巴管。除了显示SN外，在SNNS的术中管理中准确评估淋巴结转移的有无也至关重要。然而，胃癌患者淋巴结微转移（LNM）的临床意义仍存在争议。逆转录聚合酶链反应（RT-PCR）是用于识别LNM的代表性检测方法之一。最近已研发出一种快速RT-PCR检测方法，可在约40分钟内完成LNM的检测，并应用于SNNS的临床管理。从手术方法的角度来看，最近改良的腹腔镜与内镜联合非暴露入路手术作为一种有望预防手术操作引起肿瘤播散的技术受到关注，未来可能在临床上应用于SNNS。当将SNNS作为微创手术实施时，重要的是要考虑术后生活质量与治愈率之间的平衡。未来关于SNNS的前瞻性研究将极大地有助于将其进一步确立为早期胃癌患者的有益手术方法。
