Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2011

01-07-2011 | Gastrointestinal Oncology

Combination of Ex Vivo Sentinel Lymph Node Mapping and Methylene Blue-Assisted Lymph Node Dissection in Gastric Cancer: A Prospective and Randomized Study

Authors: Bruno Märkl, MD, Alexandra I. Moldovan, Hendrik Jähnig, MD, Claudio Cacchi, MD, Hanno Spatz, MD, Matthias Anthuber, MD, Daniel V. Oruzio, MD, Hallie Kretsinger, Hans M. Arnholdt, MD

Published in: Annals of Surgical Oncology | Issue 7/2011

Login to get access

Abstract

Background

Exact lymph node (LN) staging is crucial for prognosis estimation and treatment stratification in gastric cancer. Recently, a new concept for improving LN harvest and the accuracy of LN staging was introduced. It combines methylene blue-assisted lymph node dissection (MBLND) with a new ex vivo sentinel lymph node (evSLN) mapping technique. The purpose of this study was to investigate these techniques in a prospective and randomized manner.

Methods

A total of 50 patients with proven or suspicious gastric cancer were enrolled. Twenty-five patients each were randomized to the conventional technique (Unstained) or MBLND (Methylene). In 46 cases, additional evSLN mapping with black ink as a marker dye was performed.

Results

Methylene blue-assisted lymph node dissection was associated with a highly significantly improved LN harvest (36 ± 10 vs. 21 ± 10; P < 0.001). The biggest differences were seen in LNs ≤ 6 mm. In contrast to the conventional technique, neither partial gastrectomy nor preoperative chemotherapy influenced LN harvest in the methylene group. The evSLN detection rate, sensitivity, and accuracy were 87, 81, and 93%, respectively. Isolated tumor cells were detected after immunohistochemical staining in 3 of 17 cases (18%). The probability of carrying a metastasis was two times higher in evSLNs compared to non-evSLNs (44 vs. 23%; P < 0.001).

Conclusions

Methylene blue-assisted lymph node dissection is a highly effective method of improving the LN harvest in gastric cancer. Further application of evSLN mapping is feasible and has the potential to heighten the sensitivity of metastasis detection.
Literature
1.
Siewert JR, Bottcher K, Stein HJ, Roder JD. Relevant prognostic factors in gastric cancer: ten-year results of the German gastric cancer study. Ann Surg. 1998;228:449–61.PubMedCrossRef
2.
Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49.PubMedCrossRef
3.
Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359:453–62.PubMedCrossRef
4.
Wang Z, Chen JQ, Cao YF. Systematic review of D2 lymphadenectomy versus D2 with para-aortic nodal dissection for advanced gastric cancer. World J Gastroenterol. 2010;16:1138–49.PubMedCrossRef
5.
Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. West Sussex: Wiley; 2010.
6.
Ichikura T, Ogawa T, Chochi K, Kawabata T, Sugasawa H, Mochizuki H. Minimum number of lymph nodes that should be examined for the International Union against Cancer/American Joint Committee on cancer TNM classification of gastric carcinoma. World J Surg. 2003;27:330–3.PubMedCrossRef
7.
Bunt AM, Hermans J, van de Velde CJ, Sasako M, Hoefsloot FA, Fleuren G, Bruijn JA. Lymph node retrieval in a randomized trial on western-type versus Japanese-type surgery in gastric cancer. J Clin Oncol. 1996;14:2289–94.PubMed
8.
Kitagawa Y, Fujii H, Mukai M, Kubota T, Otani Y, Kitajima M. Radio-guided sentinel node detection for gastric cancer. Br J Surg. 2002;89:604–8.PubMedCrossRef
9.
Otani Y, Furukawa T, Kitagawa Y, et al. New method of laparoscopy-assisted function-preserving surgery for early gastric cancer: vagus-sparing segmental gastrectomy under sentinel node navigation. J Am Coll Surg. 2004;198:1026–31.PubMedCrossRef
10.
Märkl B, Arnholdt HM, Jähnig H, Spatz H, Anthuber M, Oruzio DV, Kerwel TG. A new concept for the role of ex vivo sentinel lymph nodes in node-negative colorectal cancer. Ann Surg Oncol. 2010;17:2647–55.PubMedCrossRef
11.
Märkl B, Wünsch K, Hebick KU, Anthuber M, Probst A, Arnholdt HM, Spatz H. Methylene blue-assisted lymph node dissection in combination with ex vivo sentinel lymph node mapping in gastric cancer. Histopathology. 2009;54:433–41.PubMedCrossRef
12.
Kerwel TG, Spatz J, Anthuber M, Wunsch K, Arnholdt H, Markl B. Injecting methylene blue into the inferior mesenteric artery assures an adequate lymph node harvest and eliminates pathologist variability in nodal staging for rectal cancer. Dis Colon Rectum. 2009;52:935–41.PubMedCrossRef
13.
Märkl B, Kerwel TG, Jähnig HG, et al. Methylene blue-assisted lymph node dissection in colon specimens: a prospective, randomized study. Am J Clin Pathol. 2008;130:913–9.PubMedCrossRef
14.
Mekenkamp LJ, van Krieken JH, Marijnen CA, van de Velde CJ, Nagtegaal ID. Lymph node retrieval in rectal cancer is dependent on many factors: the role of the tumor, the patient, the surgeon, the radiotherapist, and the pathologist. Am J Surg Pathol. 2009;33:1547–53.PubMedCrossRef
15.
Neuman H, Carey LA, Ollila DW, et al. Axillary lymph node count is lower after neoadjuvant chemotherapy. Am J Surg. 2006;191:827–9.PubMedCrossRef
16.
Rullier A, Laurent C, Capdepont M, Vendrely V, Belleannee G, Bioulac-Sage P, Rullier E. Lymph nodes after preoperative chemoradiotherapy for rectal carcinoma: number, status, and impact on survival. Am J Surg Pathol. 2008;32:45–50.PubMedCrossRef
17.
Sobin LH, Wittekind C. TNM classification of malignant tumors. Hoboken: Wiley; 2002.
18.
Bouvier AM, Haas O, Piard F, Roignot P, Bonithon-Kopp C, Faivre J. How many nodes must be examined to accurately stage gastric carcinomas? Results from a population based study. Cancer. 2002;94:2862–6.PubMedCrossRef
19.
Hundahl SA, Phillips JL, Menck HR. The National Cancer Data Base Report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy: fifth edition American Joint Committee on Cancer staging, proximal disease, and the “different disease” hypothesis. Cancer. 2000;88:921–32.PubMedCrossRef
20.
Mullaney PJ, Wadley MS, Hyde C, Wyatt J, Lawrence G, Hallissey MT, Fielding JW. Appraisal of compliance with the UICC/AJCC staging system in the staging of gastric cancer. Union Internacional Contra la Cancrum/American Joint Committee on Cancer. Br J Surg. 2002;89:1405–8.PubMedCrossRef
21.
Choi HJ, Kim YK, Kim YH, Kim SS, Hong SH. Occurrence and prognostic implications of micrometastases in lymph nodes from patients with submucosal gastric carcinoma. Ann Surg Oncol. 2002;9:13–9.PubMedCrossRef
22.
Deng H, Wu RL, Zhou HY, Huang X, Chen Y, Liu LJ. Significance of Survivin and PTEN expression in full lymph node-examined gastric cancer. World J Gastroenterol. 2006;12:1013–7.PubMed
23.
Luebke T, Baldus SE, Zirbes TK, et al. Lymph node revealing solution in gastric carcinoma does not provide upstaging of the N-status. Oncol Rep. 2005;13:361–5.PubMed
24.
Basten O, Bandorski D, Bismarck C, Neumann K, Fisseler-Eckhoff A. Acetone compression. A fast, standardized method to investigate gastrointestinal lymph nodes. Pathologe. 2010;31:218–24.PubMedCrossRef
25.
Okines A, Verheij M, Allum W, Cunningham D, Cervantes A. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v50–4.PubMedCrossRef
26.
Bembenek AE, Rosenberg R, Wagler E, et al. Sentinel lymph node biopsy in colon cancer: a prospective multicenter trial. Ann Surg. 2007;245:858–63.PubMedCrossRef
27.
Gretschel S, Bembenek A, Hunerbein M, Dresel S, Schneider W, Schlag PM. Efficacy of different technical procedures for sentinel lymph node biopsy in gastric cancer staging. Ann Surg Oncol. 2007;14:2028–35.PubMedCrossRef
28.
Asakuma M, Nomura E, Lee SW, Tanigawa N. Ancillary N.O.T.E.S. procedures for early stage gastric cancer. Surg Oncol. 2009;18:157–61.PubMedCrossRef
29.
Cahill RA, Asakuma M, Perretta S, Dallemagne B, Marescaux J. Gastric lymphatic mapping for sentinel node biopsy by natural orifice transluminal endoscopic surgery (notes). Surg Endosc. 2009;23:1110–6.PubMedCrossRef
30.
Mochiki E, Kuwano H, Kamiyama Y, et al. Sentinel lymph node mapping with technetium-99m colloidal rhenium sulphide in patients with gastric carcinoma. Am J Surg. 2006;191:465–9.PubMedCrossRef
31.
Rabin I, Chikman B, Lavy R, et al. The accuracy of sentinel node mapping according to T stage in patients with gastric cancer. Gastric Cancer. 2010;13:30–5.PubMedCrossRef
32.
Ryu K, Lee J, Kim H, Kim Y, Choi I, Bae J. Prediction of lymph nodes metastasis by sentinel node biopsy in gastric cancer. Eur J Surg Oncol. 2003;29:895–9.PubMedCrossRef
Metadata
Title
Combination of Ex Vivo Sentinel Lymph Node Mapping and Methylene Blue-Assisted Lymph Node Dissection in Gastric Cancer: A Prospective and Randomized Study
Authors
Bruno Märkl, MD
Alexandra I. Moldovan
Hendrik Jähnig, MD
Claudio Cacchi, MD
Hanno Spatz, MD
Matthias Anthuber, MD
Daniel V. Oruzio, MD
Hallie Kretsinger
Hans M. Arnholdt, MD
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1713-4

Other articles of this Issue 7/2011

Annals of Surgical Oncology 7/2011 Go to the issue

Translational Research and Biomarkers

Personalizing Thyroid Cancer Care: Are We There Yet?

Translational Research and Biomarkers

Msi-1 is a Predictor of Survival and a Novel Therapeutic Target in Colon Cancer

Translational Research and Biomarkers

Polymorphism in Epidermal Growth Factor Receptor Intron 1 Predicts Prognosis of Patients with Esophageal Cancer after Chemoradiation and Surgery

Translational Research and Biomarkers

Inhibition of p600 Expression Suppresses Both Invasiveness and Anoikis Resistance of Gastric Cancer

Bone and Soft Tissue Sarcomas

Functional Outcome of Arthrodesis with a Vascularized Fibular Graft and a Rotational Latissimus Dorsi Flap After Proximal Humerus Sarcoma Resection

Colorectal Cancer

Outcome of Laparoscopic Resection for Colorectal Cancer in Patients with High Operative Risk