Kyoko Nohara1,2, Osamu Goto3,4, Hiroya Takeuchi1,5, Motoki Sasaki6, Tadateru Maehata6, Naohisa Yahagi6, Yuko Kitagawa1. 1. Department of Surgery, Keio University School of Medicine, Tokyo, Japan. 2. Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan. 3. Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan. o-goto@nms.ac.jp. 4. Department of Gastroenterology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. o-goto@nms.ac.jp. 5. Second Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan. 6. Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND AND STUDY AIM: Standard gastrectomy with lymphadenectomy is recommended following endoscopic submucosal dissection (ESD) due to the risk of lymph-node metastasis for resected cancers. However, when lymphatic flows remain unchanged after ESD, a minimally invasive function-preserving surgery based on the sentinel node (SN) concept may be applicable. In this study, using porcine survival models, we aimed to investigate whether gastric lymphatic flows were modified following ESD. METHODS: Twelve pigs, each with one simulating lesion 3 cm in size, were used. Indocyanine green (ICG) fluid was endoscopically injected into the submucosa in four quadrants surrounding the lesion. Following laparoscopic observation of lymphatic flows, the lesions were resected by ESD. After 4 weeks, ICG fluid was injected in four quadrants surrounding the scar and lymphatic flows were observed in the same manner as the initial procedure. The distribution of lymphatic flows, including stained SNs, was compared. RESULTS: In ten lesions (83.3%), the distribution of flows remained unchanged. However, in one lesion, the flow along the right gastric epiploic artery (R-GEA) disappeared on the lesser curvature of the middle stomach. In addition, in one lesion, the flow along R-GEA emerged on the lesser curvature of the lower stomach. CONCLUSIONS: Our study revealed that, despite ESD, lymphatic flows remained unchanged in most parts of the stomach. The SN concept may be applied after ESD, except for lesions on the lesser curvature. However, in the case of the lesser curvature, special care must be given to the SN concept.
BACKGROUND AND STUDY AIM: Standard gastrectomy with lymphadenectomy is recommended following endoscopic submucosal dissection (ESD) due to the risk of lymph-node metastasis for resected cancers. However, when lymphatic flows remain unchanged after ESD, a minimally invasive function-preserving surgery based on the sentinel node (SN) concept may be applicable. In this study, using porcine survival models, we aimed to investigate whether gastric lymphatic flows were modified following ESD. METHODS: Twelve pigs, each with one simulating lesion 3 cm in size, were used. Indocyanine green (ICG) fluid was endoscopically injected into the submucosa in four quadrants surrounding the lesion. Following laparoscopic observation of lymphatic flows, the lesions were resected by ESD. After 4 weeks, ICG fluid was injected in four quadrants surrounding the scar and lymphatic flows were observed in the same manner as the initial procedure. The distribution of lymphatic flows, including stained SNs, was compared. RESULTS: In ten lesions (83.3%), the distribution of flows remained unchanged. However, in one lesion, the flow along the right gastric epiploic artery (R-GEA) disappeared on the lesser curvature of the middle stomach. In addition, in one lesion, the flow along R-GEA emerged on the lesser curvature of the lower stomach. CONCLUSIONS: Our study revealed that, despite ESD, lymphatic flows remained unchanged in most parts of the stomach. The SN concept may be applied after ESD, except for lesions on the lesser curvature. However, in the case of the lesser curvature, special care must be given to the SN concept.
Entities:
Keywords:
Early gastric cancer; Endoscopic submucosal dissection; Sentinel lymph node
Authors: Sung Gon Kim; Bang Wool Eom; Hong Man Yoon; Chan Gyoo Kim; Myeong-Cherl Kook; Young-Woo Kim; Keun Won Ryu Journal: Chin J Cancer Res Date: 2021-04-30 Impact factor: 5.087