Sentinel node mapping during laparoscopic distal gastrectomy for gastric cancer: technical notes
- 157 Downloads
With increasing experience, sentinel node navigation has been applied even to gastric cancer. Sentinel lymph nodes are identified by injecting lymphatic tracer dye and radioisotope-labeled particles around a gastric tumor into the submucosa endoscopically. The aim of this video was to demonstrate the feasibility of laparoscopic sentinel node navigation (SLN) in gastric cancer.
A 71-year-old man with a diagnosis of gastric cancer was admitted to the authors’ department. The preoperative workup demonstrated a uT1 node-negative gastric cancer. The patient was scheduled for laparoscopic distal gastrectomy with SLN. The day before surgery, the patient was submitted to endoscopy. During the procedure, the radiotracer (technetium-99) was injected at four points around the tumor. The operation was performed with the patient in the Lloyd-Davies position using four trocars. After opening of the gastrocolonic ligament, the patient underwent an intraoperative endoscopy, and blue dye (patent blue) was injected at four points around the tumor. The lymphatic basin was identified with the probe and the blue dye. The sentinel node then was identified. No pickup technique was used. A standard laparoscopic gastrectomy with intracorporeal anastomosis was concluded successfully. Through a supraumbilical incision, the specimen was extracted. The sentinel node was dissected at the bench table after the operation.
The pathologic report demonstrated a gastric carcinoma, namely, pT1, pN1 (Sentinel node (Sn), 1/36), G3 gastric cancer. Only the sentinel node was positive, containing a micrometastasis. The patient’s postoperative course was uneventful.
Sentinel node navigation with a double tracer during laparoscopic gastrectomy for cancer is feasible. Nevertheless, it is mandatory to standardize the method of SLN identification to increase the diagnosis of lymph node metastases.
KeywordsGastrectomy Laparoscopy Sentinel node
Unable to display preview. Download preview PDF.
Elena Orsenigo, Saverio Di Palo, Edi Viale, Enzo Masci, carla canevari, Luigi Gianolli, and Carlo Staudacher have no conflicts of interest or financial ties to disclose.
Supplementary material 1 (MPG 71748 kb)
- 2.Takahashi N, Nimura H, Fujita T, Mitsumori N, Kashiwagi H, Yanaga K (2009) Detection of sentinel node by fluorescence and infrared ray imaging system in gastric cancer. Ann Surg Oncol 16:1720Google Scholar
- 6.Yaguchi Y, Ichikura T, Ono S, Tsujimoto H, Sugasawa H, Sakamoto N, Matsumoto Y, Yoshida K, Kosuda S, Hase K (2008) How should tracers be injected to detect for sentinel nodes in gastric cancer: submucosally from inside or subserosally from outside of the stomach? J Exp Clin Cancer Res 3:27–29Google Scholar
- 7.Pocard M, Sabourin JC (2008) Sentinel lymph node biopsy in gastrointestinal surgery: facts and future implications. J Chir Paris 4:12S17–12S20Google Scholar