Skip to main content

Advertisement

SpringerLink
Log in

Suitability of Sentinel Node Mapping as an Index of Metastasis in Early Gastric Cancer Following Endoscopic Resection

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

When pathological diagnosis following endoscopic resection (ER) for early gastric cancer (EGC) suggests probable lymph node metastasis, additional surgery with lymphadenectomy should be performed. The sentinel node (SN) concept has yet to be applied to tumors following ER. The aim of this study was to evaluate the feasibility of SN navigation surgery for such tumors.

Methods

Forty patients diagnosed with EGC lesions <4 cm in diameter underwent gastrectomy with SN mapping following ER. A technetium-99 m tin colloid solution and a dye were injected into the submucosal layer around the post-ER scar in all four abdominal quadrants. We then compared the SN distribution and metastases among the patients who underwent ER and controls (n = 192).

Results

SNs were identifiable in all patients, and the mean number of SNs per case was 4.9. The location of the SN basin was similar in the patients who underwent ER and the controls. One patient (3 %) whose primary tumor had invaded the submucosal layer had a metastatic SN. The median time from ER to surgery was 73 days. No postoperative recurrence was observed in any patient over a median follow-up of 1,023 days.

Conclusions

Our findings suggest that the SN basin is not greatly affected by ER. The SN concept could be suitable for tumors following ER, but conventional gastrectomy with lymphadenectomy involving the SN basin should be used at present.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Referencess

  1. Carter KJ, Schaffer HA, Ritchie WP Jr. Early gastric cancer. Ann Surg. 1984;199:604–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Everett SM, Axon AT. Early gastric cancer in Europe. Gut. 1997;41:142–150.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Murakami T. Pathomorphological diagnosis: definition and gross classification of early gastric cancer. Gann Monogr Cancer Res. 1971;11:53–5.

    Google Scholar 

  4. Japanese Gastric Cancer Association Registration Committee, Maruyama K, Kaminishi M, et al. Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry. Gastric Cancer. 2006;9:51–66.

    Article  PubMed  Google Scholar 

  5. Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.

    Article  PubMed  Google Scholar 

  6. Wong JH, Cagle LA, Morton DL. Lymphatic drainage of skin to a sentinel lymph node in a feline model. Ann Surg. 1991;214:637–41.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.

    Article  CAS  PubMed  Google Scholar 

  8. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–8. discussion 398–401.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Kitagawa Y, Fujii H, Mukai M, et al. Radio-guided sentinel node detection for gastric cancer. Br J Surg. 2002;89:604–8.

    Article  CAS  PubMed  Google Scholar 

  10. Kitagawa Y, Saikawa Y, Takeuchi H, et al. Sentinel node navigation in early stage gastric cancer–updated data and current status. Scand J Surg. 2006;95:256–9.

    CAS  PubMed  Google Scholar 

  11. Saikawa Y, Otani Y, Kitagawa Y, et al. Interim results of sentinel node biopsy during laparoscopic gastrectomy: possible role in function-preserving surgery for early cancer. World J Surg. 2006;30:1962–8.

    Article  PubMed  Google Scholar 

  12. Takeuchi H, Oyama T, Kamiya S, et al. Laparoscopy-assisted proximal gastrectomy with sentinel node mapping for early gastric cancer. World J Surg. 2011;35:2463–71.

    Article  PubMed  Google Scholar 

  13. Kitagawa Y, Takeuchi H, Takagi Y, et al. Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol. 2013;31:3704–10.

    Article  PubMed  Google Scholar 

  14. Kitagawa Y, Kitano S, Kubota T, et al. Minimally invasive surgery for gastric cancer–toward a confluence of two major streams: a review. Gastric Cancer. 2005;8:103–10.

    Article  PubMed  Google Scholar 

  15. Takeuchi H, Kitagawa Y. New sentinel node mapping technologies for early gastric cancer. Ann Surg Oncol. 2013;20:522–32.

    Article  PubMed  Google Scholar 

  16. Tada M, Karita M, Yanai H, Takemoto T. Endoscopic therapy of early gastric cancer by strip biopsy. Gan To Kagaku Ryoho. 1988;15:1460–5.

    CAS  PubMed  Google Scholar 

  17. Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol. 2006;41:929–42.

    Article  PubMed  Google Scholar 

  18. Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer. 2007;10:1–11.

    Article  PubMed  Google Scholar 

  19. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.

    Google Scholar 

  20. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011;14:101–12.

    Article  Google Scholar 

  21. Japanese Gastric Cancer Assocation. Japanese Classification of Gastric Carcinoma: 2nd English edition. Gastric Cancer. 1998;1:10–24.

    Article  Google Scholar 

  22. UCC. TNM classification of malignant tumours. Weinheim: Wiley; 2009.

    Google Scholar 

  23. Hirao M, Masuda K, Asanuma T, et al. Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointest Endosc. 1988;34:264–9.

    Article  CAS  PubMed  Google Scholar 

  24. Tada M, Murakami A, Karita M, et al. Endoscopic resection of early gastric cancer. Endoscopy. 1993;25:445–50.

    Article  CAS  PubMed  Google Scholar 

  25. Inoue H, Takeshita K, Hori H, et al. Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc. 1993;39:58–62.

    Article  CAS  PubMed  Google Scholar 

  26. Yamamoto H, Yube T, Isoda N, et al. A novel method of endoscopic mucosal resection using sodium hyaluronate. Gastrointest Endosc. 1999;50:251–6.

    Article  CAS  PubMed  Google Scholar 

  27. Fujishiro M, Yahagi N, Kashimura K, et al. Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection. Endoscopy. 2004;36:579–83.

    Article  CAS  PubMed  Google Scholar 

  28. Ono H, Hasuike N, Inui T, et al. Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer. Gastric Cancer. 2008;11:47–52.

    Article  PubMed  Google Scholar 

  29. Takeuchi H, Fujii H, Ando N, et al. Validation study of radio-guided sentinel lymph node navigation in esophageal cancer. Ann Surg. 2009;249:757–63.

    Article  PubMed  Google Scholar 

  30. Kinami S, Fujimura T, Ojima E, et al. PTD classification: proposal for a new classification of gastric cancer location based on physiological lymphatic flow. Int J Clin Oncol. 2008;13:320–9.

    Article  PubMed  Google Scholar 

  31. Yasuda K, Shiraishi N, Suematsu T, et al. Rate of detection of lymph node metastasis is correlated with the depth of submucosal invasion in early stage gastric carcinoma. Cancer. 1999;85:2119–23.

    Article  CAS  PubMed  Google Scholar 

  32. Morita S, Katai H, Saka M, et al. Outcome of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg. 2008;95:1131–5.

    Article  CAS  PubMed  Google Scholar 

  33. Nunobe S, Sasako M, Saka M, et al. Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer. 2007;10:167–72.

    Article  PubMed  Google Scholar 

  34. Ichikawa D, Ueshima Y, Shirono K, et al. Esophagogastrostomy reconstruction after limited proximal gastrectomy. Hepatogastroenterology. 2001;48:1797–801.

    CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Shuhei Mayanagi MD, Hiroya Takeuchi MD, PhD, Satoshi Kamiya MD, Masahiro Niihara MD, Rieko Nakamura MD, PhD, Tsunehiro Takahashi MD, PhD, Norihito Wada MD, PhD, Hirofumi Kawakubo MD, PhD, Yoshiro Saikawa MD, PhD, Tai Omori MD & Yuko Kitagawa MD, PhD

  2. Department of Radiology, Keio University School of Medicine, Tokyo, Japan

    Tadaki Nakahara MD, PhD

  3. Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan

    Makio Mukai MD, PhD

Authors
  1. Shuhei Mayanagi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroya Takeuchi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Satoshi Kamiya MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masahiro Niihara MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rieko Nakamura MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tsunehiro Takahashi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Norihito Wada MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hirofumi Kawakubo MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yoshiro Saikawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tai Omori MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tadaki Nakahara MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Makio Mukai MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Yuko Kitagawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroya Takeuchi MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mayanagi, S., Takeuchi, H., Kamiya, S. et al. Suitability of Sentinel Node Mapping as an Index of Metastasis in Early Gastric Cancer Following Endoscopic Resection. Ann Surg Oncol 21, 2987–2993 (2014). https://doi.org/10.1245/s10434-014-3662-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-3662-1

Keywords

Search

Navigation