Top

Published in:

01-02-2017 | ORIGINAL ARTICLE

Laparoscopic sentinel node navigation surgery for early gastric cancer: a prospective multicenter trial

Authors: Naoto Takahashi, Hiroshi Nimura, Tetsuji Fujita, Norio Mitsumori, Norio Shiraishi, Seigo Kitano, Hitoshi Satodate, Katsuhiko Yanaga

Published in: Langenbeck's Archives of Surgery | Issue 1/2017

Abstract

Background

Prospective multicenter trials have shown the feasibility of sentinel node (SN) navigation surgery using a dual tracer of dye and radioisotope for early gastric cancer. However, comparable trials using the indocyanine green (ICG) and the infrared ray laparoscopic system (IRLS) have not been reported. On the basis of our cohort studies, we assumed that the ICG imaging with the IRLS is as effective as the dual tracer in detecting SNs. Therefore, we conducted a prospective multicenter trial to assess the effectiveness and generalizability of the infrared ICG technique in patients with early gastric cancer.

Patients and methods

Patients with previously untreated cT1 gastric adenocarcinomas less than 4 cm in gross diameter were eligible for inclusion in this study. SN mapping was performed by using ICG combined with IRLS technique. Following biopsy of the identified SNs, D2 or modified D2 laparoscopic gastrectomy was performed according to the current Japanese Gastric Cancer Association guidelines.

Results

Among the 47 patients who gave written informed consent, 44 were eligible from the surgical findings, for whom SN biopsy was performed. The detection rate of the lymphatic basin by the ICG with IRLS was 100% (44/44). The accuracy was also 100% (7/7) for detecting metastatic lymph node, which was verified on the permanent pathologic examination. Following the median follow-up of 114 months (range, 60 to 120 months), no recurrence (0/40) was observed. Although the number of patients was unequally distributed among the hospitals participating in the trial, the detection rates of SNs in low-volume hospitals were comparable to those in high-volume hospitals. Consequently, there was no learning curve in this trial.

Conclusion

The infrared ICG imaging accurately detected the lymphatic basin and SNs with occult metastasis in SN-navigated gastrectomy for gastric cancer. This method was feasible even for low-volume surgeons and hospitals.

Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, Intra M, Veronesi P, Robertson C, Maisonneuve P, Renne G, De Cicco C, De Lucia F, Gennari R (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349:546–553CrossRefPubMed

Morton DL, Thompson JF, Essner R, Elashoff R, Stern SL, Nieweg OE, Roses DF, Karakousis CP, Mozzillo N, Reintgen D, Wang HJ, Glass EC, Cochran AJ (1999) Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Ann Surg 230:453–463CrossRefPubMedPubMedCentral

Ryu KW, Eom BW, Nam BH, Lee JH, Kook MC, Choi IJ, Kim YW (2011) Is the sentinel node biopsy clinically applicable for limited lymphadenectomy and modified gastric resection in gastric cancer? A meta-analysis of feasibility studies. J Surg Oncol 104:578–584CrossRefPubMed

Kitagawa Y, Fujii H, Kumai K, Kubota T, Otani Y, Saikawa Y, Yoshida M, Kubo A, Kitajima M (2005) Recent advances in sentinel node navigation for gastric cancer: a paradigm shift of surgical management. J Surg Oncol 90:147–151CrossRefPubMed

Kinami S, Fujimura T, Ojima E, Fushida S, Ojima T, Funaki H, Fujita H, Takamura H, Ninomiya I, Nishimura G, Kayahara M, Ohta T, Yoh Z (2008) PTD classification: proposal for a new classification of gastric cancer location based on physiological lymphatic flow. Int J Clin Oncol 13:320–329CrossRefPubMed

Miwa K, Kinami S, Taniguchi K, Fushida S, Fujimura T, Nonomura A (2003) Mapping sentinel nodes in patients with early-stage gastric carcinoma. Br J Surg 90:178–182CrossRefPubMed

Hiratsuka M, Miyashiro I, Ishikawa O, Furukawa H, Motomura K, Ohigashi H, Kameyama M, Sasaki Y, Kabuto T, Ishiguro S, Imaoka S, Koyama H (2001) Application of sentinel node biopsy to gastric cancer surgery. Surgery 129:335–340CrossRefPubMed

Kitagawa Y, Saikawa Y, Takeuchi H, Mukai M, Nakahara T, Kubo A, Kitajima M (2006) Sentinel node navigation in early stage gastric cancer—updated data and current status. Scand J Surg 95:256–259CrossRefPubMed

Nimura H, Narimiya N, Mitsumori N, Yamazaki Y, Yanaga K, Urashima M (2004) Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer. Br J Surg 91:575–579CrossRefPubMed

10.

Kelder W, Nimura H, Takahashi N, Mitsumori N, van Dam GM, Yanaga K (2010) Sentinel node mapping with indocyanine green (ICG) and infrared ray detection in early gastric cancer: an accurate method that enables a limited lymphadenectomy. Eur J Surg Oncol 36:552–558CrossRefPubMed

11.

Kitagawa Y, Takeuchi H, Takagi Y, Natsugoe S, Terashima M, Murakami N, Fujimura T, Tsujimoto H, Hayashi H, Yoshimizu N, Takagane A, Mohri Y, Nabeshima K, Uenosono Y, Kinami S, Sakamoto J, Morita S, Aikou T, Miwa K, Kitajima M (2013) Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol 31:3704–3710CrossRefPubMed

12.

Lee YJ, Jeong SH, Hur H, Han SU, Min JS, An JY, Hyung WJ, Cho GS, Jeong GA, Jeong O, Park YK, Jung MR, Kim YW, Yoon HM, Eom BW, Park JY, Ryu KW; Sentinel Node Oriented Tailored Approach (SENORITA) Study Group (2015) Prospective multicenter feasibility study of laparoscopic sentinel basin dissection for organ preserving surgery in gastric cancer: quality control study for surgical standardization prior to phase III trial. Medicine (Baltimore).;bb94:e1894. doi: 10.1097/MD.0000000000001894

13.

Miyashiro I, Hiratsuka M, Sasako M, Sano T, Mizusawa J, Nakamura K, Nashimoto A, Tsuburaya A, Fukushima N, Gastric Cancer Surgical Study Group (GCSSG) in the Japan Clinical Oncology Group (JCOG) (2014) High false-negative proportion of intraoperative histological examination as a serious problem for clinical application of sentinel node biopsy for early gastric cancer: final results of the Japan clinical oncology group multicenter trial JCOG0302. Gastric Cancer 17:316–323CrossRefPubMed

14.

Tonouchi H, Mohri Y, Tanaka K, Kobayashi M, Ohmori Y, Kusunoki M (2005) Laparoscopic lymphatic mapping and sentinel node biopsies for early-stage gastric cancer: the cause of false negativity. World J Surg 29:418–421CrossRefPubMed

15.

Ishikawa K, Yasuda K, Shiromizu A, Etoh T, Shiraishi N, Kitano S (2007) Laparoscopic sentinel node navigation achieved by infrared ray electronic endoscopy system in patients with gastric cancer. Surg Endosc 21:1131–1134CrossRefPubMed

16.

Lee JH, Ryu KW, Lee SE, Cho SJ, Lee JY, Kim CG, Choi IJ, Kook MC, Kim MJ, Park SR, Lee JS, Nam BH, Kim YW (2009) Learning curve for identification of sentinel lymph node based on a cumulative sum analysis in gastric cancer. Dig Surg 26:465–470CrossRefPubMed

17.

Verbeek FP, Troyan SL, Mieog JS, Liefers GJ, Moffitt LA, Rosenberg M, Hirshfield-Bartek J, Gioux S, van de Velde CJ, Vahrmeijer AL, Frangioni JV (2014) Near-infrared fluorescence sentinel lymph node mapping in breast cancer: a multicenter experience. Breast Cancer Res Treat 143:333–342CrossRefPubMed

18.

Plante M, Touhami O, Trinh XB, Renaud MC, Sebastianelli A, Grondin K, Gregoire J (2015) Sentinel node mapping with indocyanine green and endoscopic near-infrared fluorescence imaging in endometrial cancer. A pilot study and review of the literature. Gynecol Oncol 137:443–447CrossRefPubMed

19.

Kusano M, Tajima Y, Yamazaki K, Kato M, Watanabe M, Miwa M (2008) Sentinel node mapping guided by indocyanine green fluorescence imaging: a new method for sentinel node navigation surgery in gastrointestinal cancer. Dig Surg 25:103–108CrossRefPubMed

20.

Zelken JA, Tufaro AP. 2015. Current trends and emerging future of indocyanine green usage in surgery and oncology: an update Ann Surg Oncol; Suppl 3:S1271-S1283.

Title: Laparoscopic sentinel node navigation surgery for early gastric cancer: a prospective multicenter trial
Authors: Naoto Takahashi
Hiroshi Nimura
Tetsuji Fujita
Norio Mitsumori
Norio Shiraishi
Seigo Kitano
Hitoshi Satodate
Katsuhiko Yanaga
Publication date: 01-02-2017
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 1/2017
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-016-1540-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Laparoscopic sentinel node navigation surgery for early gastric cancer: a prospective multicenter trial

Abstract

Background

Patients and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2017

Rescue ALPPS is efficient and safe after failed portal vein occlusion in patients with colorectal liver metastases

Liver mobilization and liver hanging for totally laparoscopic right hepatectomy: an easy way to do it

Postoperative ileus: in search of an international consensus on definition, diagnosis, and treatment

Mortality-related risk factors and long-term survival after 4460 liver resections in Sweden—a population-based study

Liver transplantation in infants with biliary atresia: comparison of primary versus temporary abdominal closure

Career intentions of female surgeons in German liver transplant centers considering family and lifestyle priorities