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筋络操ORIGINAL ARTICLE
借条模板个人The ef?ciency of micrometastasis by ntinel node navigation surgery using indocyanine green and infrared ray laparoscopy system for gastric cancer
Kentaro Yano ?Hiroshi Nimura ?Norio Mitsumori ?
Naoto Takahashi ?Hideyuki Kashiwagi ?Katsuhiko Yanaga
Received:4May 2011/Accepted:23September 2011
漫步雨中
óThe International Gastric Cancer Association and The Japane Gastric Cancer Association 2011
Abstract
Background The clinical application of ntinel node navigation surgery (SNNS)for patients
with gastric cancer requires accurate intraoperative diagnosis of lymph node metastasis.However,the clinical signi?cance of the diag-nosis of lymph node micrometastasis for gastric cancer has not been established.In this study,we evaluated lymph nodes discted during SNNS by immunohistochemistry with anti-cytokeratin antibody (IHC)staining for gastric cancer to investigate the ufulness of SNNS.
Patients and methods The subjects were 130patients with gastric cancer (3,381lymph nodes)who underwent SNNS with infrared ray obrvation and lymph node dis-ction of D1?a or more.The discted lymph nodes were stained with IHC (CAM 5.2),and the results were com-pared with intra-and postoperative diagnos by hema-toxylin and eosin (H&E)staining.In addition,the association of metastatic lymph nodes and ICG-positive lymph nodes was examined.
Results The number of patients (lymph nodes)with lymph node metastasis by HE and IHC staining was 16(52nodes)and 31(91nodes),respectively.Fifteen patients (27nodes)diagnod with pN0by HE staining were diagnod to be metastatic by IHC staining.The tumor depth of the patients was pT1in ten patients (m,3;sm,7)and pT2in
奇客岛
红牡丹鹦鹉ve (mp,4;ss,1).Regarding the histological type,three patients were classi?ed as well-differentiated type,while six patients each had moderately and poorly differentiated types.The grade of lymphatic invasion was ly0in 5,ly1in 6,and ly2in 4,respectively.Histological asssment of 27IHC-positive and HE-negative cells indicated 5single cells,16clusters,and 6micrometastas.The lymph nodes were all included in the ntinel nodes (SN)identi-?ed during surgery.All but one patient (0.8%)were recurrence-free at 2–8years after surgery (median 74.7months).The one patient developed anastomotic recurrence 4.5years after the ?rst operation and died.Conclusion Since all 27lymph nodes in 15patients with metastasis by IHC staining but not by HE staining were micrometastasis or less and included in the SN,ICG-positive lymphatic basin disction by SNNS with infrared ray obrvation ems to be an adequate method of lymph node disction for gastric cancer.
Keywords Sentinel node navigation surgery áInfrared ray áMicrometastasis áCytokerartin áGastric cancer
Introduction
汉字来源
In Japan,D2lymph node disction in gastric cancer surgery is a standard technique for advanced gastric cancer to achieve acceptable long-term outcomes [1].Recently,however,partial lymph node disction and limited surgery for early gastric cancer have been described in the guidelines from the Japane Gastric Cancer Association [2].Among early gastric cancers,intramucosal carcinoma has been shown to exhibit minimal change of lymph node metastasis,for which endoscopic mucosal rection (EMR)and endo-scopic submucosal disction (ESD)are commonly
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We con?rm that this manuscript has not been published or submitted for publication elwhere except as a brief abstract in the proceedings of a scienti?c meeting or symposium.
K.Yano (&)áH.Nimura áN.Mitsumori áN.Takahashi áH.Kashiwagi áK.Yanaga
Department of Surgery,The Jikei University School of Medicine,3-25-8Nishi-shinbashi,Minato-ku,Tokyo 105-8461,Japan e-mail:****************.jp
Gastric Cancer
DOI 10.1007/s10120-011-0105-6
performed[3].Although approximately20%of cancers clinically diagnod as intramucosal carcinoma have been con?rmed to invade the submucosa(SM)or more by path-ological diagnosis[4],Gotoda et al.[5]showed that no lymph node metastasis was evident in gastric cancers that are SM1,differentiated carcinoma without lymphatic invasion, and3cm or less in size.Since patients without such factors or tho who have the possibility for lymph node metastasis bad on pathological?ndings diagnod after EMR or ESD are treated with salvage surgery associated with lymph node disction,it should be reasonable to establish to what extent lymph node disction should be performed.One of the approaches is the ntinel node(SN)concept,which has recently attracted attention in malignant melanoma and breast cancer[6,7].
Many clinical studies on SN for gastric cancer have been conducted in Japan and have shown good results[8–23]. We invented an infrared ray obrvation method for SN identi?cation and performed ntinel node navigation sur-gery(SNNS)[17,20].However,thi
s approach cannot be applied in practice without accurate intraoperative meta-static diagnosis of the identi?ed SN.Accurate intraopera-tive diagnosis of lymph node metastasis is very important for developing the strategy to perform minimally invasive surgery.Thin slice and immunostaining are considered ideal for rapid intraoperative diagnosis and are feasible in many institutions the days,but we mostly had to choo hematoxylin and eosin(H&E)staining of frozen ctions. We examined all of the lymph nodes discted in SNNS stained with H&E as well as immunohistochemistry with anti-cytokeratin antibody(IHC)to investigate whether intraoperative diagnosis was possible and whether clinical application of SNNS by infrared ray obrvation is feasible.
