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Sentinel node mapping for post-endoscopic resection gastric cancer: multicenter retrospective cohort study in Japan

内镜下胃癌切除术后前哨淋巴结标测: 日本多中心回顾性队列研究

  • 影响因子:4.87
  • DOI:10.1007/s10120-019-01038-3
  • 作者列表:"Mayanagi, Shuhei","Takahashi, Naoto","Mitsumori, Norio","Arigami, Takaaki","Natsugoe, Shoji","Yaguchi, Yoshihisa","Suda, Takeshi","Kinami, Shinichi","Ohi, Masaki","Kawakubo, Hirofumi","Sato, Yasunori","Takeuchi, Hiroya","Aikou, Takashi","Kitagawa, Yuko","Japanese Society for Sentinel Node Navigation Surgery
  • 发表时间:2020-01-11
Abstract

Background Standard gastrectomy with systematic lymphadenectomy as an additional surgery after endoscopic resection (ER) causes a deterioration in long-term quality of life. If the sentinel lymph node (SN) basin concept can be applied in post-ER gastric cancer, minimal surgery can be applied without reducing the curability. This retrospective multicenter cohort study aimed to verify the validity of the SN basin concept in post-ER gastric cancer. Patients and methods Individual data of 132 patients who underwent SN mapping after ER were collected from 8 university hospitals in Japan from 2001 to 2016. Tracers were injected endoscopically in the submucosal layer at four sites around the post-ER scar. We compared the SN basin distribution of post-ER gastric cancer with that of 275 patients with non-ER gastric cancer. Results Two cases of SN were unidentified, both involving a single tracer (SN detection rate: 98.5%). Nine cases (6.8%) of lymph node metastasis were found, of which eight had a metastatic lymph node within the SNs and one had a non-SN metastasis within the SN basin. The diagnostic sensitivity of SN mapping for lymph node metastasis was 88.9% in post-ER group and 95.7% in non-ER group ( P  = 0.490); the accuracy was 99.2% and 99.6% ( P  = 0.539), respectively. Regarding the SN basin, no significant intergroup differences were found regardless of the primary tumor location. Conclusions Our findings clarified the feasibility of SN mapping based on the SN basin concept in patients with gastric cancer who previously underwent ER.

摘要

背景标准胃切除术联合系统性淋巴结切除术作为内镜切除术 (ER) 后的一项额外手术,会导致长期生活质量的恶化。如果前哨淋巴结 (SN) 盆地概念可以应用于 ER 术后胃癌,则可以在不降低可治愈性的情况下应用微创手术。这项回顾性多中心队列研究旨在验证 SN 盆地概念在 ER 后胃癌中的有效性。患者和方法收集了 2001年至 2016年日本 8 所大学医院 132 例接受 ER 后 SN 映射的患者的个体资料。在 ER 后瘢痕周围四个部位的粘膜下层内镜下注射示踪剂。我们比较了 ER 后胃癌与 275 例非 ER 胃癌患者的 SN 盆地分布。结果 2 例 SN 不明,均累及单一示踪剂 (SN 检出率: 98.5%)。发现淋巴结转移 9 例 (6.8%),其中 8 例 SNs 内淋巴结转移,1 例 SN 盆地内无 SN 转移。SN mapping 对淋巴结转移的诊断敏感性在 ER 后组为 88.9%,在非 ER 组为 95.7% (P = 0.490); 准确率分别为 99.2% 和 99.6% (P = 0.539)。关于 SN 盆地,无论原发肿瘤位置如何,均未发现显著的组间差异。结论我们的研究结果阐明了在既往接受过 ER 的胃癌患者中基于 SN 盆地概念进行 SN 映射的可行性。

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