BACKGROUND: Recently, some studies have suggested that sentinel node biopsy also can be applied to gastric cancer. The authors apply sentinel lymph node biopsy in laparoscopy assisted distal gastrectomy to perform it as safe limited surgery. Limited surgery is a procedure in which the extent of lesion resection and lymph node dissection is reduced. The authors demonstrate that intraoperative diagnosis of lymph node metastasis is useful in this respect. METHODS: The study was conducted with 38 patients (29 men and 9 women) who had a preoperative diagnosis of T1 tumor invasion. The patients had a mean age of 66.2 years. Patent blue (1%) was injected submucosally into four or five different sites around the primary tumor at 1 ml per site. Blue-stained lymphatics and lymph nodes could be seen by turning over the greater omentum and the lesser omentum extraperitoneally. If blue nodes were found, biopsy was performed. RESULTS: The mean number of blue nodes dissected was 2.5 +/- 1.9. Intraoperative identification and biopsy of blue nodes could be performed for 35 (92.1%) of the 38 patients. Of the 35 patients in whom blue nodes were identified, 4 (9.7%) had metastases in blue nodes confirmed by intraoperative frozen-section diagnosis. Intraoperative frozen-section diagnosis was negative for blue node metastasis in 31 patients. Postoperative permanent section diagnosis also showed no evidence of lymph node metastasis in these 31 patients (100% accuracy, 0% false-negative rates). CONCLUSION: The reported method allows observation of blue-stained lymphatics up to 2 h after patent blue injection. Sentinel node biopsy was performed in laparoscopy assisted distal gastrectomy, making it technically equivalent to open gastrectomy. Sentinel node biopsy can serve as a method to determine the appropriate use of laparoscopy assisted distal gastrectomy for management of T1 gastric cancer.
BACKGROUND: Recently, some studies have suggested that sentinel node biopsy also can be applied to gastric cancer. The authors apply sentinel lymph node biopsy in laparoscopy assisted distal gastrectomy to perform it as safe limited surgery. Limited surgery is a procedure in which the extent of lesion resection and lymph node dissection is reduced. The authors demonstrate that intraoperative diagnosis of lymph node metastasis is useful in this respect. METHODS: The study was conducted with 38 patients (29 men and 9 women) who had a preoperative diagnosis of T1 tumor invasion. The patients had a mean age of 66.2 years. Patent blue (1%) was injected submucosally into four or five different sites around the primary tumor at 1 ml per site. Blue-stained lymphatics and lymph nodes could be seen by turning over the greater omentum and the lesser omentum extraperitoneally. If blue nodes were found, biopsy was performed. RESULTS: The mean number of blue nodes dissected was 2.5 +/- 1.9. Intraoperative identification and biopsy of blue nodes could be performed for 35 (92.1%) of the 38 patients. Of the 35 patients in whom blue nodes were identified, 4 (9.7%) had metastases in blue nodes confirmed by intraoperative frozen-section diagnosis. Intraoperative frozen-section diagnosis was negative for blue node metastasis in 31 patients. Postoperative permanent section diagnosis also showed no evidence of lymph node metastasis in these 31 patients (100% accuracy, 0% false-negative rates). CONCLUSION: The reported method allows observation of blue-stained lymphatics up to 2 h after patent blue injection. Sentinel node biopsy was performed in laparoscopy assisted distal gastrectomy, making it technically equivalent to open gastrectomy. Sentinel node biopsy can serve as a method to determine the appropriate use of laparoscopy assisted distal gastrectomy for management of T1 gastric cancer.
Authors: Gary H Lyman; Armando E Giuliano; Mark R Somerfield; Al B Benson; Diane C Bodurka; Harold J Burstein; Alistair J Cochran; Hiram S Cody; Stephen B Edge; Sharon Galper; James A Hayman; Theodore Y Kim; Cheryl L Perkins; Donald A Podoloff; Visa Haran Sivasubramaniam; Roderick R Turner; Richard Wahl; Donald L Weaver; Antonio C Wolff; Eric P Winer Journal: J Clin Oncol Date: 2005-09-12 Impact factor: 44.544
Authors: M Hiratsuka; I Miyashiro; O Ishikawa; H Furukawa; K Motomura; H Ohigashi; M Kameyama; Y Sasaki; T Kabuto; S Ishiguro; S Imaoka; H Koyama Journal: Surgery Date: 2001-03 Impact factor: 3.982
Authors: U Veronesi; G Paganelli; V Galimberti; G Viale; S Zurrida; M Bedoni; A Costa; C de Cicco; J G Geraghty; A Luini; V Sacchini; P Veronesi Journal: Lancet Date: 1997-06-28 Impact factor: 79.321
Authors: Y Kitagawa; H Fujii; M Mukai; T Kubota; N Ando; M Watanabe; M Ohgami; Y Otani; S Ozawa; H Hasegawa; T Furukawa; K Kumai; T Ikeda; T Nakahara; A Kubo; M Kitajima Journal: Surg Clin North Am Date: 2000-12 Impact factor: 2.741
Authors: John C Kang; Leslie A Wanek; Richard Essner; Mark B Faries; Leland J Foshag; Donald L Morton Journal: J Clin Oncol Date: 2005-07-20 Impact factor: 44.544