Conflicts of interest: The authors have no conflict of interest.
Feasibility of sentinel node navigation surgery after noncurative endoscopic resection for early gastric cancer
Article first published online: 22 JUL 2013
© 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 28, Issue 8, pages 1343–1347, August 2013
How to Cite
Arigami, T., Uenosono, Y., Yanagita, S., Matsushita, D., Arima, H., Hirata, M., Uchikado, Y., Nakajo, A., Okumura, H., Ishigami, S., Hokita, S. and Natsugoe, S. (2013), Feasibility of sentinel node navigation surgery after noncurative endoscopic resection for early gastric cancer. Journal of Gastroenterology and Hepatology, 28: 1343–1347. doi: 10.1111/jgh.12269
- Issue published online: 22 JUL 2013
- Article first published online: 22 JUL 2013
- Accepted manuscript online: 10 MAY 2013 10:29AM EST
- Manuscript Accepted: 18 APR 2013
- Ministry of Education, Science, Sports, Culture and Technology, Japan. Grant Number: 22791256
- endoscopic resection;
- gastric cancer;
- sentinel node navigation surgery
Background and Aim
Recently, the use of additional surgery after noncurative endoscopic resection has gradually increased due to the rapid spread of endoscopic treatments in selected patients with early gastric cancer. Sentinel node navigation surgery (SNNS) has also been recognized as a minimally invasive surgery with personalized lymphadenectomy in early gastric cancer. Here, we assessed the feasibility of SNNS after noncurative endoscopic resection for early gastric cancer.
Sixteen patients with early gastric cancer, in whom additional surgery had been indicated due to noncurative endoscopic resection, were enrolled. They underwent a gastrectomy with standard lymphadenectomy. One day before surgery, 99mtechnetium-tin colloid was endoscopically injected into the submucosa around the tumor. After surgery, the uptake of radioisotope in dissected lymph nodes was measured using Navigator GPS. Then, all dissected lymph nodes were investigated by hematoxylin-eosin staining and immunohistochemistry using an antihuman cytokeratin monoclonal antibody.
Hematoxylin-eosin staining demonstrated lymph node metastasis in two (12.5%) of 16 patients and in three (0.8%) of 382 nodes. However, immunohistochemistry showed that none of the patients had lymph node micrometastasis. Sentinel nodes (SNs) were identified in all patients. The mean number of SNs was 3.1 (range, 1–6). Among two patients with lymph node metastasis, the SNs, at least, contained positive nodes. Accordingly, the false-negative and accuracy rates were 0% and 100%, respectively.
Our results indicate that SNNS may have potential as a further minimally invasive surgery in early gastric cancer patients after noncurative endoscopic resection.