Extended application of sentinel node navigation surgery to gastric cancer

前哨淋巴结导航手术在胃癌中的推广应用

基本信息

批准号：
15390390
负责人：
MIWA Koichi
金额：
$ 8.51万
依托单位：
Kanazawa University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B)
财政年份：
2003
资助国家：
日本
起止时间：
2003 至 2004
项目状态：
已结题

项目摘要

We developed the intraoperative endoscopic lymphatic mapping (IELM) for identifying sentinel lymph nodes of patients with early-stage gastric cancer (EGC). A total of 126 patients with EGC underwent the IELM. The patent blue (a lymphophilic dye) was intraoperatively injected into the surrounding mucosa of tumor by using electronic endoscopy. Some lymph nodes were stained blue several minutes after this procedure. We named a stained lymph node a blue node (BN) and an area including stained nodes and lymphatics a lymphatic basin. After IELM we performed lymphatic basin dissection with intraoperative pathology, and finally standard gastrectomy with D2. IELM succeeded in 119 patients (94%) with a good performance of 87% (34/39) in sensitivity, 100% (80/80) in specificity, and 96% (114/119) in accuracy. Five false negatives consisted of four gross metastases and one overlooked metastasis at intraoperative diagnosis. Lymphatic metastases in 33 of 34 (97%) patients were detected in BNs alone, … More or BNs and non-BNs in the basin, which included BNs. These results suggested that if lymphatic metastases in BNs in the dissected basin were not proven in the intraoperative pathology, limited nodal dissection and limited gastric resection could be applicable in EGC. We applied sleeve gastric resection (SGR) to 51 EGC patients and its postoperative quality of life (QOL) was compared with the QOL of 61 patients undergoing conventional Billroth I (B-I) reconstruction. The incidence of the patients who could eat more than 80% of preoperative oral intake in SGR group was high as 80% compared to 67% in B-I group. Dumpers in SGR group were 5% significantly fewer than 18% in B-I group. The incidences of intragastric bile reflux and mucosal redness by endoscopy in SGR group (0% and 46%) were significantly lower than those in B-I group (41% and 82%). These results suggested that limited surgery based on IELM and basin dissection was feasible and beneficial for the postoperative QOL in EGC patients.We also applied the sentinel node mapping to 43 rectal cancer patients by RI method. The ^<99m>Tc-phytate was preoperatively injected into the surrounding mucosa of tumor by using electronic endoscopy. The hot nodes were intraoperatively detected using γ-probe. In the patients with the invasion up to submucosa, RI-mapping succeeded in 25 of 26 patients (96%) with a good performance of 80% (4/5) in sensitivity, 100% (20/20) in specificity, and 96% (24/25) in accuracy. But six of 17 patients with the invasion deeper than submucosa showed false negative. Technical improvement should be needed in sentinel node mapping of rectal cancer Less

我们开发了术中内镜淋巴图谱 (IELM)，用于识别早期胃癌 (EGC) 患者的前哨淋巴结。共有 126 名 EGC 患者在术中注射了专利蓝（aophil 淋巴染料）。在此过程后几分钟，使用电子内窥镜检查肿瘤周围的粘膜，一些淋巴结被染成蓝色，我们将染色的淋巴结命名为蓝色节点（BN）以及包括染色节点和的区域。 IELM 后，我们进行了术中病理学的淋巴盆切除术，最终 119 例患者 (94%) 成功完成了标准胃切除术，敏感性为 87% (34/39)，100%。特异性为 80/80)，准确度为 96% (114/119)。 5 个假阴性包括 4 个肉眼转移瘤和 1 个被忽视的转移瘤。术中诊断时，34 名患者中的 33 名（97%）在 BN 中检测到淋巴转移，或在盆地中检测到 BN 和非 BN，这些结果表明，如果解剖中的 BN 中存在淋巴转移。术中病理学尚未证实，有限淋巴结清扫和有限胃切除术适用于 EGC。 51例EGC患者及其术后生活质量（QOL）与61例接受传统Billroth I（B-I）重建的患者的QOL进行比较，SGR组中能够进食超过术前摄食量80%的患者发生率较高。 SGR 组的胃内胆汁反流发生率为 80%，而 B-I 组的发生率为 5%，显着低于 B-I 组的 18%。 SGR 组的粘膜发红程度（0% 和 46%）明显低于 B-I 组（41% 和 82%），这些结果表明基于 IELM 和盆解剖的有限手术是可行的，并且有利于术后。 EGC患者的生活质量。我们还通过RI方法对43例直肠癌患者进行了前哨淋巴结定位，术前将^<99m>Tc-植酸注射到了43例直肠癌患者中。术中使用γ探针检测到肿瘤周围粘膜的热结点，在26例患者中，25例（96%）的RI成像成功，表现良好，达80%。敏感性为 (4/5)，特异性为 100% (20/20)，准确性为 96% (24/25)，但 17 名患者中有 6 名出现侵袭。直肠癌前哨淋巴结定位较粘膜下层显示假阴性需技术改进。

项目成果

期刊论文数量（34）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

胃癌リンパ区域郭清術

胃癌淋巴结清扫术

DOI：
发表时间：
2003
期刊：
手術 57
影响因子：
0
作者：
Hiromichi Kawaida;Koji Kono;Akihiro Takahashi;Hidemitsu Sugai;Kosaku Mimura;Naoto Miyagawa;Hideo Omata;Hiroshi Kumamoto;Akishi Ooi;Hideki Fujii;三輪晃一
通讯作者：
三輪晃一

Anti-metastatic effect of capecitabine on human colon cancer xenografts in nude mouse rectum

卡培他滨对人结肠癌裸鼠直肠移植瘤的抗转移作用