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Laparoscopic sentinel node navigation surgery for early gastric cancer: a prospective multicenter trial

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Abstract

Background

Prospective multicenter trials have shown the feasibility of sentinel node (SN) navigation surgery using a dual tracer of dye and radioisotope for early gastric cancer. However, comparable trials using the indocyanine green (ICG) and the infrared ray laparoscopic system (IRLS) have not been reported. On the basis of our cohort studies, we assumed that the ICG imaging with the IRLS is as effective as the dual tracer in detecting SNs. Therefore, we conducted a prospective multicenter trial to assess the effectiveness and generalizability of the infrared ICG technique in patients with early gastric cancer.

Patients and methods

Patients with previously untreated cT1 gastric adenocarcinomas less than 4 cm in gross diameter were eligible for inclusion in this study. SN mapping was performed by using ICG combined with IRLS technique. Following biopsy of the identified SNs, D2 or modified D2 laparoscopic gastrectomy was performed according to the current Japanese Gastric Cancer Association guidelines.

Results

Among the 47 patients who gave written informed consent, 44 were eligible from the surgical findings, for whom SN biopsy was performed. The detection rate of the lymphatic basin by the ICG with IRLS was 100% (44/44). The accuracy was also 100% (7/7) for detecting metastatic lymph node, which was verified on the permanent pathologic examination. Following the median follow-up of 114 months (range, 60 to 120 months), no recurrence (0/40) was observed. Although the number of patients was unequally distributed among the hospitals participating in the trial, the detection rates of SNs in low-volume hospitals were comparable to those in high-volume hospitals. Consequently, there was no learning curve in this trial.

Conclusion

The infrared ICG imaging accurately detected the lymphatic basin and SNs with occult metastasis in SN-navigated gastrectomy for gastric cancer. This method was feasible even for low-volume surgeons and hospitals.

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Abbreviations

ICG:

Indocyanine green

SN:

Sentinel node

SNNS:

Sentinel node navigation surgery

IRLS:

Infrared ray laparoscopic system

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Acknowledgements

The authors thank the following members for their help in collecting the data in the trial: Kazuhiro Yasuda, Haruhiro Inoue, Junichi Tanaka, Shinei Kudo, and Tomoki Koyama.

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Authors and Affiliations

  1. Department of Surgery, Kashiwa Hospital, The Jikei University School of Medicine, 163-1 Kashiwashita, Kashiwashi, Chiba, 277-0004, Japan

    Naoto Takahashi

  2. Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan

    Hiroshi Nimura, Tetsuji Fujita, Norio Mitsumori & Katsuhiko Yanaga

  3. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Oita, Japan

    Norio Shiraishi & Seigo Kitano

  4. Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

    Hitoshi Satodate

Authors
  1. Naoto Takahashi
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  2. Hiroshi Nimura
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  3. Tetsuji Fujita
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  8. Katsuhiko Yanaga
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Corresponding author

Correspondence to Naoto Takahashi.

Ethics declarations

Ethics and consent

The study protocol and publication of the study results including the personal details were approved by the Institutional Review Board of the Jikei University Scholl of Medicine (Reference No.15-53) and all local institutional review boards. Written informed consent was obtained from all patients.

Conflict of interest

All authors declare that they have no conflict of interest.

Author’s contributions

Naoto Takahashi, Hiroshi Nimura, Seigo Kitano, and Katsuhiko Yanaga conceived the study and analyzed the data. Norio Mitsumori, Norio Shiraishi, and Hitoshi Satodate helped collect the clinical data. Naoto Takahashi, Hiroshi Nimura, and Tetsuji Fujita drafted and revised the manuscript on behalf of all authors. All authors read and approved the final manuscript.

Availability of data and materials

We clarified that the datasets supporting the conclusions of this article are included within the article.

Funding

We received no support from any funding.

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Takahashi, N., Nimura, H., Fujita, T. et al. Laparoscopic sentinel node navigation surgery for early gastric cancer: a prospective multicenter trial. Langenbecks Arch Surg 402, 27–32 (2017). https://doi.org/10.1007/s00423-016-1540-y

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  • DOI: https://doi.org/10.1007/s00423-016-1540-y

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