Secondary sentinel lymph node tracing technique: a new method for tracing lymph nodes in radical gastrectomy for advanced gastric cancer

Journal of Zhejiang University-SCIENCE B, Nov 2015

Objective To explore the feasibility and clinical value of secondary sentinel lymph node (SSLN) tracing technique in radical gastrectomy for advanced gastric cancer (AGC). Methods From January 2009 to June 2011, 247 patients who suffered from gastric angle cancer with metastasis in No. 3 group lymph nodes were divided randomly into groups A and B. Methylthioninium chloride was injected into the peripheral tissue of the metastatic No. 3 group lymph nodes of 138 patients in group A before tumor resections. SSLNs were traced and individual lymphadenectomies were carried out based on the biopsy results of the SSLNs. Standard D2 radical gastrectomies were carried out directly on 109 patients in group B. Postoperative follow-up and survival analysis were carried out for patients in both groups. Results SSLNs were found in 114 (82.6%) patients in group A. Ninety of those patients (78.9%) demonstrated existing metastasis in SSLNs. According to Kaplan-Meier’s method, the postoperative 3-year cumulative survival rates were 63.5% and 47.5%, and the median survival time were 40 and 36 months for the patients of groups A and B, respectively (P<0.05). Conclusions The SSLN tracing technique is feasible in radical gastrectomy for AGC. It gives surgeons important information about the terminal status of lymph node metastasis and provides some scientific basis for individual lymphadenectomy.

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Secondary sentinel lymph node tracing technique: a new method for tracing lymph nodes in radical gastrectomy for advanced gastric cancer

J Zhejiang Univ-Sci B (Biomed & Biotechnol) 1673-1581 Secondary sentinel lymph node tracing technique: a new method for tracing lymph nodes in radical Zong-lin LI 2 Huai-wu JIANG 1 Min SONG 0 Liang XU 2 Dong XIA 2 Qing LIU 2 0 Department of Laboratory Medicine, the First Affiliated Hospital of Sichuan Medical University , Luzhou 646000 , China) 1 Department of Gastrointestinal Surgery, the Second Affiliated Hospital of North Sichuan Medical College , Mianyang 621000 , China) 2 Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sichuan Medical University , Luzhou 646000 , China) 3 Project supported by the Projects of Sichuan Provincial Health Department Scientific Research (Nos. 050182 and 090250), China ORCID: Zong-lin LI Objective: To explore the feasibility and clinical value of secondary sentinel lymph node (SSLN) tracing technique in radical gastrectomy for advanced gastric cancer (AGC). Methods: From January 2009 to June 2011, 247 patients who suffered from gastric angle cancer with metastasis in No. 3 group lymph nodes were divided randomly into groups A and B. Methylthioninium chloride was injected into the peripheral tissue of the metastatic No. 3 group lymph nodes of 138 patients in group A before tumor resections. SSLNs were traced and individual lymphadenectomies were carried out based on the biopsy results of the SSLNs. Standard D2 radical gastrectomies were carried out directly on 109 patients in group B. Postoperative follow-up and survival analysis were carried out for patients in both groups. Results: SSLNs were found in 114 (82.6%) patients in group A. Ninety of those patients (78.9%) demonstrated existing metastasis in SSLNs. According to Kaplan-Meier's method, the postoperative 3-year cumulative survival rates were 63.5% and 47.5%, and the median survival time were 40 and 36 months for the patients of groups A and B, respectively (P<0.05). Conclusions: The SSLN tracing technique is feasible in radical gastrectomy for AGC. It gives surgeons important information about the terminal status of lymph node metastasis and provides some scientific basis for individual lymphadenectomy. Secondary sentinel lymph node (SSLN); Advanced gastric cancer (AGC); Individual lymphadenectomy; Survival analysis doi; 10; 1631/jzus; B1500053 Document code; A CLC number; R735; 2 1 Introduction Sentinel lymph nodes (SLNs) refer to those lymph nodes which are the first to directly receive the lymphatic drainage of primary tumors and which are most likely to contain metastases. SLNs can be more than one lymph node and also can exist in more than one direction (Fig. 1) (Chen et al., 2006; Tangoku et al., 2007) . SLN tracing techniques have been widely used in clinical practice for many solid tumors such as melanoma, breast cancer, and colorectal carcinoma, and excellent clinical results have been achieved (Shimazu and Noguchi, 2011; Erman et al., 2012; van der Zaag et al., 2012) . Some preliminary research on SLN tracing techniques has been carried out since the concept of SLN was introduced to the area of gastric cancer in the 1990s. The techniques have generally been found to be valuable in the treatment of early gastric cancer (EGC) but of little or no value in the treatment of advanced gastric cancer (AGC). This is because, in AGC, real SLNs could not be found by routine SLN tracing techniques (Dong et al., 2012; Tóth et al., 2012; Chen et al., 2014; Symeonidis et al., 2014) . Therefore, exploring the detection methods and assessing the value of SLN tracing techniques in AGC is of great significance. Based on the accumulated knowledge, we proposed the concept of secondary sentinel lymph nodes (SSLNs). SSLNs refer to those SLNs which are identified according to the basic methods for detecting SLN, and by injecting tracer into the peripheral tissue of metastatic lymph nodes to trace lymph nodes which are beyond those metastatic lymph nodes (Fig. 2). We used the SSLN tracing technique to research AGC, aiming at providing some scientific basis for individual lymphadenectomy in radical gastrectomy of AGC. SLN Primary tumor SLN Lymphatic network 2 Patients and methods 2.1 Patients From January 2009 to June 2011, 247 patients were enrolled in the study, consisting of 135 males and 112 females, aged from 38 to 67 years old and with a median age of 52 years. They were treated at the First Affiliated Hospital of Sichuan Medical University (Luzhou, China). All of these patients were suffering from gastric angle cancer accompanied by metastatic nodule formation of the No. 3 group lymph nodes. The identifying criteria were: (1) No. 3 group lymph nodes were found during surgery to be enlarged, hard, and accompanied by cancerous nodule formation or fusion; (2) No. 3 group lymph nodes were found to contain cancer cells by postoperative pathological examination. No metastatic nodule formation was found in other groups of lymph nodes. The primary tumors of these patients were localized, witho (...truncated)


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Zong-lin Li, Huai-wu Jiang, Min Song, Liang Xu, Dong Xia, Qing Liu. Secondary sentinel lymph node tracing technique: a new method for tracing lymph nodes in radical gastrectomy for advanced gastric cancer, Journal of Zhejiang University-SCIENCE B, 2015, pp. 897-903, Volume 16, Issue 11, DOI: 10.1631/jzus.B1500053