Assessment of lymph node micrometastasis in early gastric cancer in relation to sentinel nodes

被引：52

作者：

Miyake K. ^{[1
]}

Seshimo A. ^{[1
]}

Kameoka S. ^{[1
]}

机构：

[1] Department of Surgery II, Tokyo Women's Medical University, Shinjuku-ku, Tokyo 162-8666

来源：

Gastric Cancer | 2006年 / 9卷 / 3期

关键词：

EMR; Lymph node micrometastasis; Reduced surgery; SNNS;

D O I：

10.1007/s10120-006-0378-3

中图分类号：

学科分类号：

摘要：

Background. The development of endoscopic resection and reduced surgical procedures has progressed in recent years. Lymph node micrometastases can be cited as one of the problems with reduced operations. In this study, we investigated clinicopathological findings and sentinel lymph nodes (SNs) for associations with micrometastases. We discuss the indications for endoscopic mucosal resection (EMR), reduced surgery, and sentinel node navigation surgery (SNNS) based on the results. Methods. Immunostaining with anti-cytokeratin antibodies was used as the method of exploring for micrometastases. Comparisons and assessments were made in regard to the presence or absence of micrometastases and various clinicopathological factors. Results. The relationship between the clinicopathological factors and micrometastases was investigated in 120 patients with pT1pN0 gastric cancer. Significant differences in depth of invasion (mucosal [m] versus submucosal [sm]) and histological type (differentiated versus undifferentiated) were observed in both univariate analysis and multivariate analysis. Micrometastases were observed in 32% of the sm cancers, and they were observed in group 2 lymph nodes (no. 7) in 8%. They tended to be more common in the undifferentiated type. The micrometastatic lymph nodes were restricted to blue nodes (BNs) and lymph nodes within the dye flow area of patent blue (used intraoperatively explore for SNs). Conclusion. It is considered that the indications for current EMR and reduced surgery in early gastric cancer are valid from the standpoint of micrometastases. But if the SNNS that has been studied in recent years is introduced, the lymphatic basin dissection method seems valid only if the case is s-pN0 early cancer. © 2006 by International and Japanese Gastric Cancer Associations.

引用

页码：197 / 202

页数：5

共 33 条

[1]

Nashimoto A., Morota T., Yabusaki H., Tsuchiya Y., Tanaka O., Sasaki J., Investigation of postoperative ileus after gastrectomy and prevention of ileus by limited surgery for early gastric cancer, Jpn J Gastroenterol Surg, 33, pp. 1455-60, (2000)

[2]

Takayama N., Et al., Modified surgery for early gastric cancer-lymph nodes dissection with preserving hepatic and celiac branch of the vagus nerve, Jpn J Cancer Clin, 45, pp. 647-56, (1999)

[3]

Arita A., Et al., Assessment of function in a reconstructive procedure following distal gastrectomy for early gastric cancer-focusing on the usefulness of vagus nerve preservation and pylorus preservation gastrectomy (PPG), Jpn J Med, 3899, pp. 25-30, (1999)

[4]

Isozaki H., Nomura E., Tanigawa M., Assessment of function preserving gastrectomy for early gastric cancer, Jpn J Cancer Chemother, 25, pp. 493-7, (1998)

[5]

Kitano S., Shiraishi N., Fujii K., Yasuda K., Inomata M., Adachi Y., A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer

[6]

An interim report, Surgery, 131, pp. 306-11, (2002)

[7]

Siewert J.R., Kestlmeier R., Busch R., Bottcher K., Roder J.D., Muller J., Et al., Benefit of D2 lymph node dissection for patients with gastric cancer and pN0 and pN1 lymph node metastases, Br J Surg, 83, pp. 1144-7, (1996)

[8]

Kobayashi K., Nakanishi H., Masuda A., Tezuka N., Mutai M., Tatematsu M., Sequential observation of micrometastasis formation by bacterial lacZ gene-tagged Lewis lung carcinoma cells, Cancer Lett, 112, pp. 191-8, (1997)

[9]

Scheunemann P., Izbicki J.R., Pantel K., Tumorigenic potential of apparently tumor-free lymph nodes, N Engl J Med, 340, (1998)

[10]

Nakajo A., Natsugoe S., Ishigami S., Matsumoto M., Nakashima S., Hokita S., Et al., Detection and prediction of micrometastasis in the lymph nodes of patients with pN0 gastric cancer, Ann Surg Oncol, 8, pp. 158-62, (2001)

← 1 2 3 4 →