Y. Yaguchi1, S. Hiraki1, S. Nomura1, H. Horiguchi1, I. Kumano1, R. Takahata1, M. Hoshikawa1, T. Einama1, Y. Kajiwara1, T. Noro1, E. Shinto1, S. Aosasa1, H. Tsujimoto1, T. Ichikura2, J. Yamamoto1, H. Ueno1. 1Department of Surgery, National Defense Medical College, 2Imperial Household Agency
Background: We have performed sentinel node (SN) biopsy for SN navigation surgery (SNNS) by laparotomy from 2002, and previously reported an optimal detection method of SNs under laparotomy for the complicated lymphatic flow of the stomach (J Exp Clin Cancer Res. 2008). The aim of this feasibility study was to evaluate laparoscopic SN biopsy for laparoscopic SNNS in early gastric cancer patients.
Subjects and methods: This study includes 13 patients with cT1N0M0 (primary tumor <4 cm) gastric cancer who underwent laparoscopic SN biopsy in conjunction with radioisotope and dye methods between Jan. 2010 and Jul. 2011. First, we looked for green-dyed SNs after injection of indocyanine green (ICG) without near-infrared light system, and then tried to detect the radioactivity of SNs using a hand-held gamma probe inserted through a small incision at the umbilical port. After the areas where SNs were distributed were resected, a gastrectomy with prophylactic lymphadenectomy was performed according to the gastric cancer treatment guidelines of the Japanese Gastric Cancer Association. We looked for undetected SNs in the resected specimen at the back table.
Results: Among 13 cases, there were 11 (85%) in which SNs were not detected in the resected specimen. There were 2 cases in whom SNs were detected in the resected specimen. In both cases, the primary tumors were located in the middle and greater curvature of the stomach. In Case 1, laparoscopic SN biopsy identified the left (4sb) and right (4d) greater-curvature lymph node (LNs) as SNs, however, lesser-curvature (3) and infrapyloric (6) LNs remained as SNs in the resected specimen. In Case 2, the left (4sb) and right (4d) greater-curvature LNs were identified as SNs intraoperatively, while the lesser-curvature (3) LN remained as an SN in the resected specimen. The SNs overlooked with laparoscopic SN biopsy method were detected by radioisotope only. No cases had LN metastasis, and the 5-year relapse-free survival rate of these 13 patients was 100%.
Conclusions: Our feasibility study of laparoscopic sentinel node biopsy for early gastric cancer showed that we should search for SNs of the lesser curvature carefully even if the primary lesion is located at the greater curvature.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88292
Program Number: P829
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster