Sentinel Node Navigation Surgery in Patients with Early Gastric Cancer

Takeuchi, Hiroya; Kitagawa, Yuko

doi:10.1159/000350875

Cited by 47 publications

(38 citation statements)

References 33 publications

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“…An important issue is whether the lymphatic flow from the primary tumor to the original SN(s) changes after EMR/ESD. Our preliminary study showed that the sentinel lymphatic basin was not markedly affected by previous EMR/ESD [26,27]. Modified gastrectomy based on the SN distribution and metastatic status may be feasible, even for patients who underwent EMR/ESD before surgery.…”

Section: Clinical Application Of Laparoscopic Sn Mapping In Early Gasmentioning

confidence: 76%

“…Theoretically, if the SN(s) is/are pathologically negative for cancer metastasis, EMR/ESD may be sufficient for the curative resection of cT1 gastric cancer beyond the EMR criteria (Fig. 2d) [26,27]. However, further studies are required to verify the safety and effectiveness of combined treatments involving laparoscopic SN biopsy and EMR/ESD.…”

Section: Clinical Application Of Laparoscopic Sn Mapping In Early Gasmentioning

confidence: 99%

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Function-preserving gastrectomy based on the sentinel node concept in early gastric cancer

et al. 2016

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Recent meta-analyses and a prospective multicenter trial of sentinel node (SN) mapping in early gastric cancer have demonstrated acceptable SN detection rates and accuracy of determination of lymph node status. SN mapping may play a key role in obtaining individual metastatic information. It also allows modification of surgical procedures, including function-preserving gastrectomy in patients with early gastric cancer. A dual-tracer method that uses radioactive colloids and blue dye is currently considered the most reliable method for the stable detection of SNs in patients with early gastric cancer. New technologies, such as indocyanine green infrared or fluorescence imaging, are also useful for accurate SN mapping in gastric cancer. Theoretically, laparoscopic function-preserving gastrectomy, including partial resection, proximal gastrectomy, segmental gastrectomy, and pylorus-preserving gastrectomy, is feasible in early gastric cancer when the SN(s) is/are nonmetastatic. Our study group conducted a multicenter prospective trial in Japan to evaluate function-preserving gastrectomy with SN mapping for long-term survival and patient quality of life. Nonexposed endoscopic wall-inversion surgery (NEWS) is a new technique for treating gastric cancer with partial resection involving full-thickness resection with endoscopy and laparoscopic surgery without transluminal access. The combination of NEWS and SN biopsy is expected to be a promising, minimally invasive, function-preserving surgery that is ideal for cases of cN0 early gastric cancer.

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Section: Clinical Application Of Laparoscopic Sn Mapping In Early Gasmentioning

confidence: 76%

Section: Clinical Application Of Laparoscopic Sn Mapping In Early Gasmentioning

confidence: 99%

Function-preserving gastrectomy based on the sentinel node concept in early gastric cancer

et al. 2016

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“…As the standard surgical treatment in colorectal cancer, intestinal resection and regional lymphadenectomy, including feeding arteries, is considered essential (13,14). In GBC up to stage IIa, the frequency of lymph node metastasis in the pericholedochal area has been reported to be higher compared to that of lymph node metastasis around the hepatic artery (2,3).…”

Section: Discussionmentioning

confidence: 99%

“…From the present study, the right route is considered part of the route of the eRHA. To completely remove the lymphatic basin in the eRHA route, resection of the nodes in the pericholedochal area, posterosuperior pancreaticoduodenal area and retroportal area should also be performed (14). This consideration is undoubtedly a key reason as to why the addition of PD is associated with improved prognosis for patients with GBC (17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Lymph node spread of gallbladder cancer from the perspective of embryologically-based anatomy and significance of the lymphatic basin along the embryonic right hepatic artery

Nakagawara

Tajima

Miyashita

et al. 2014

Molecular and Clinical Oncology

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Abstract. Lymph node metastasis from gallbladder cancer is often found in the pericholedochal area; however, these regional lymph nodes are not typically accompanied by arteries. We hypothesized that the artery accompanying pericholedochal lymph nodes was either the regressed embryonic right hepatic artery (eRHA) or an aberrant right hepatic artery (aRHA) remaining without regression. This study aimed to determine the artery supplying pericholedochal lymph nodes. We obtained serial tissue sections of resected specimens from 10 patients who underwent pancreaticoduodenectomy with combined resection of the superior mesenteric artery and vein and investigated the association between the distribution of enlarged lymph nodes and the course of blood vessels in each section. In 2 cases with aRHA, enlarged lymph nodes were distributed in the posterosuperior area, pancreaticoduodenal region and retroportal area along this artery. By contrast, no blood vessels accompanied enlarged lymph nodes in 8 patients exhibiting a normal hepatic artery branching pattern, although these nodes exhibited a distribution pattern similar to that of patients with the aRHA. Thus, the artery supplying pericholedochal lymph nodes appears to be either the regressed eRHA or an aRHA persisting without regression. IntroductionThe prognosis of gallbladder cancer (GBC) with lymph node metastases is poor. The 5-year survival rate following surgical resection has been reported to be 65% for patients with no lymph node metastases and <30% for those with regional lymph node metastases (pN1) (1). In the pN1 group, lymph node metastases characteristically arise in the pericholedochal area or the posterosuperior pancreaticoduodenal region, rather than around the hepatic artery (2,3). However, no feeding arteries are present around the pericholedochal lymph nodes and posterosuperior pancreaticoduodenal lymph nodes (PPLNs), although lymph nodes and lymphatic vessels generally exist along a feeding artery (4-7).We previously performed pancreaticoduodenectomy (PD) for pancreatic cancer in patients with an aberrant right hepatic artery (aRHA). In such cases, PPLNs were distributed along the aRHA. This artery is considered to represent an embryonic right hepatic artery (eRHA) that has not regressed. We hypothesized that the artery responsible for PPLNs would be the eRHA. If this hypothesis is accurate, lymphadenectomy for GBC should be performed based on the course of the eRHA (8). The aim of this study was to determine the artery supplying the PPLNs. Materials and methodsPatients. Between 1997 and 2005, a total of 58 patients underwent PD for invasive pancreatic ductal cancer in the Department of Gastroenterologic Surgery at Kanazawa University. Among these cases, radical PD with major vessel resection [superior mesenteric artery (SMA) and superior mesenteric vein (SMV) resection] was performed in 18 patients for complete clearance of the soft tissues around these arteries (9). This study was approved by the Ethics Committee at our institution and was conducted ...

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“…On the contrary, it remains controversial whether SN mapping would be feasible after ESD because the lymphatic flow from the primary tumor site where ESD is performed remains unknown. However, a previous study suggested that at least the SN basin was not markedly changed in patients who underwent ESD prior to surgery [29,30]. Regarding the combination treatment of ESD and SN biopsy, further studies are required to confirm safety and efficacy.…”

Section: Present Status and Future Prospects Of Sn Navigation Surgerymentioning

confidence: 97%

Minimally Invasive Function-Preserving Gastrectomy with Sentinel Node Biopsy for Early Gastric Cancer

et al. 2018

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Background: Recently, minimally invasive approaches such as endoscopic treatment or laparoscopic gastrectomy for early gastric cancer have made rapid progress. However, the extent of gastrectomy and lymphadenectomy in laparoscopic surgery is radical, similar to that of open gastrectomy for patients with early gastric cancer diagnosed as not indicated for endoscopic treatment. Since it is well known that lymph node metastasis is an important prognostic factor, the standard procedure of gastrectomy with radical lymph node dissection has been performed for the purpose of curative resection. The frequency of lymph node metastases is relatively low in patients with early gastric cancer; therefore, function-preserving gastrectomy, a solution between endoscopic treatment and standard gastrectomy in terms of invasiveness, could be considered to avoid excessive invasive surgery. Summary: A prospective multicenter trial and meta-analyses of sentinel node (SN) mapping and biopsy for early gastric cancer demonstrated favorable SN detection rates and accuracy of nodal metastatic status. Personalized function-preserving gastrectomy with limited lymphadenectomy using SN theory will positively impact patients’ quality of life (QOL). Specifically, a full-thickness partial gastrectomy by laparoscopic endoscopic cooperative surgery with SN basin dissection could become a reliable technique of minimally invasive gastrectomy for treating patients with clinically node-negative (cN0) early gastric cancer. Key Messages: For early gastric cancer, the development of laparoscopic personalized minimized gastrectomy with SN navigation may improve patients’ postoperative QOL.

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Sentinel Node Navigation Surgery in Patients with Early Gastric Cancer

Cited by 47 publications

References 33 publications

Function-preserving gastrectomy based on the sentinel node concept in early gastric cancer

Function-preserving gastrectomy based on the sentinel node concept in early gastric cancer

Lymph node spread of gallbladder cancer from the perspective of embryologically-based anatomy and significance of the lymphatic basin along the embryonic right hepatic artery

Minimally Invasive Function-Preserving Gastrectomy with Sentinel Node Biopsy for Early Gastric Cancer

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