Problems of Sentinel Node Navigation Surgery of Early Gastric Cancer Treatment by Intraoperative Dye Injection Method in Terms of Nodal Micrometastasis

Tomoyuki Nakasato, Akiyoshi Seshimo and Shingo Kameoka

Department of Surgery II, Tokyo Women's Medical University

Sentinel node navigation surgery (SNNS) is based on the sentinel node (SN) concept. The lymphatic channel is complicated in gastric cancer, so we must be prudent in attempting SNNS. We studied the propriety of intraoperative subserosal dye injection for detecting SNs and ideal SNNS avoiding radical operation. Subjects and Methods: 1) We conducted intraoperative subserosal dye injection in 78 patients with gastric cancer (pathological depth M-SE). The blue node (BN) was confirmed in each case, providing 100.0% detection rate, 98.7% accuracy and 93.3% sensitivity. 2) Of these cases, 53 cases had pathological depth of M-SM and no lymph node metastasis histologically, we conducted immunostaining for all 1,329 dissected lymph nodes. We detected micrometastasis in 10 of the 53. All micrometastasis was in the dye-stained lymphatic channel. We then studied micrometastasis in 5 cases of pathological depth of SM (162 dissected nodes) with nodal metastasis-positive cases. Two cases had extra-channel nodal micrometastasis in this advanced cancer group. Conclusion: From our result of BN detection by intraoperative subserosal dye injection, SN was included in BN. And from the results of micrometastasis detection, in early gastric cancer, although no metastasis is seen in HE staining, lymph nodes should be dissected along with the lymphatic channel stained by intraoperative subserosal dye injection.

Key words
gastric cancer, sentinel node navigation surgery, micrometastasis

Reprint requests
Tomoyuki Nakasato Department of Surgery II, Tokyo Women's Medical University
8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 JAPAN

Accepted
December 19, 2003

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