Endoscopic Submucosal Dissection Combined Laparoscopic Sentinel Lymph Node Biopsy for Early Gastric Cancer:A Report of 26 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 JIANGKai ¹ , FEIBo-jian ¹ , GAOQi-zhong ¹ ,  TUHui-ming ²

1. Department of General Surgery, Affiliated Hospital of Jiangnan University(Wuxi Fourth People's Hospital), Wuxi 214000, Jiangsu Province, China;
2. Department of Gastroenterology, Affiliated Hospital of Jiangnan University(Wuxi Fourth People's Hospital), Wuxi 214000, Jiangsu Province, China;

Corresponding author：

TUHui-ming, Email: thmercp@hotmail.com

Keywords：

Early gastric cancer; Endoscopic submucosal dissection; Laparoscopic sentinel lymph node biopsy

DOI：

10.7507/1007-9424.20140201

Video：

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Objective To explore the feasibility and clinical efficacy of laparoscopic sentinel lymph node biopsy combined with endoscopic submucosal dissection(ESD) for patients with early gastric cancer(EGC). Methods The clinical data of 26 cases who received ESD combined with laparoscopic sentinel lymph node biopsy for EGC between March 2009 to August 2013 in Affiliated Hospital of Jiangnan University were analyzed retrospectively. These patients first underwent laparoscopic sentinel lymph node(SLN) biopsy. If frozen sectioning examination suggested there was lymph node metastasis, laparoscopic D2 radical gastrectomy would be operated. However, the ESD would be operated if the frozen sectioning examination was negative. Results The total numbers of SLN were 95, and mean numbers of SLN were 3.7±1.4(range from 1 to 6). Two patients with positive SLN underwent laparoscopic-assisted distal gastrectomy and 24 patients with negative SLN underwent ESD. The disease free survival(DFS) and local recurrence rate after ESD for EGC was 91.7%(22/24) and 4.2%(1/24), respectively. And the total DFS for all patients was 96.2% (25/26). Conclusion ESD for EGC is a safe and feasible procedure, combined with laparoscopic sentinel lymph node biopsy conforms more to the concept of principle of radical operation.

Citation： JIANGKai, FEIBo-jian, GAOQi-zhong, TUHui-ming. Endoscopic Submucosal Dissection Combined Laparoscopic Sentinel Lymph Node Biopsy for Early Gastric Cancer:A Report of 26 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(7): 851-854. doi: 10.7507/1007-9424.20140201 Copy

1.	Ahn JY, Jung HY. Long-term outcome of extended endoscopic submucosal dissection for early gastric cancer with differentiated histology[J]. Clin Endoc, 2013, 46(5):463-466.
2.	Omae M, Fujisaki J, Horiuchi Y, et al. Safety, efficacy, and long-term outcomes for endoscopic submucosal dissection of early esophagogastric junction cancer[J]. Gastric Cancer, 2013, 16(2):147-154.
3.	Abe S, Oda I, Suzuki H, et al. Short-and long-term outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer[J]. Endoscopy, 2013, 45(9):703-707.
4.	许啸声, 郑民华.前哨淋巴结活检在早期胃癌淋巴结转移评估中的作用[J].外科理论与实践, 2010, 15(2):194-196.
5.	陈秀峰, 张波, 杨弘鑫, 等.早期胃癌前哨淋巴结的临床研究[J].四川大学学报:医学版, 2013, 44(1):151-154.
6.	Rothbarth J, Wijnhoven BP. Lymphatic dissemination and the role of sentinel lymph node biopsy in early gastric cancer[J]. Dig Surg, 2012, 29(2):130-131.
7.	内镜黏膜下剥离术专家协作组.消化道黏膜病变内镜黏膜下剥离术治疗专家共识[J].中华胃肠外科杂志, 2012, 15(10): 1083-1086.
8.	Washington K. 7^th of the AJCC cancer staging manual:stomach[J]. Ann Surg Oncol, 2010, 17(12):3077-3079.
9.	Nam BH, Kim YW, Reim D, et al. Laparoscopy assisted versus open distal gastrectomy with D2 lymph node dissection for advanced gastric cancer:design and rationale of a phaseⅡrandomized controlled multicenter trial (COACT 1001)[J]. J Gastric Cancer, 2013, 13(3):164-171.
10.	徐均, 董永红, 赵宝玉, 等.腹腔镜辅助下远端胃癌D2清扫入路的临床分析[J].中华胃肠外科杂志, 2012, 15(12): 1269-1272.
11.	唐波, 余佩武.腹腔镜胃癌D2手术淋巴结清扫原则与技巧[J].中国普外基础与临床杂志, 2011, 18(2):114-115.
12.	Son SY, Park JY, Ryu KW, et al. The risk factors for lymph node metastasis in early gastric cancer patients who underwent endoscopic resection:is the minimal lymph node dissection applicable? A retrospective study[J]. Surg Endosc, 2013, 27(9): 3247-3253.
13.	周平红, 张轶群.胃肠道早期癌的内镜粘膜下剥离术治疗[J].中华临床医师杂志:电子版, 2012, 6(21):6627-6629.
14.	Chiu PW, Teoh AY, To KF, et al. Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia:a retrospective cohort study[J]. Surg Endosc, 2012, 26(12):3584-3591.
15.	Yasunaga H, Horiguchi H, Kuwabara K, et al. Outcomes after laparoscopic or open distal gastrectomy for early-stage gastric cancer:a propensity-matched analysis[J]. Ann Surg, 2013, 257(4):640-646.
16.	余佩武.腹腔镜胃癌手术的进展与展望[J].中国普外基础与临床杂志, 2011, 18(2):105-109.
17.	Choi MK, Kim GH, Park do Y, et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer:a single-center experience[J]. Surg Endosc, 2013, 27(11):4250-4258.
18.	Leong SP, Kim J, Ross M, et al. A phase 2 study of 99Tcmtilmanocept in the detection of sentinel lymph nodes in melanoma and breast cancer[J]. Ann Surg Oncol, 2011, 18(4):961-969.
19.	Quan ML, McCready D. The evolution of lymph node assessment in breast cancer[J]. J Surg Oncol, 2009, 99(4):194-198.
20.	Jones EL, Jones TS, Pearlman NW, et al. Long-term follow-up and survival of patients following a recurrence of melanoma after a negative sentinel lymph node biopsy result[J]. JAMA Surg, 2013, 148(5):456-461.
21.	Tajima Y, Murakami M, Yamazaki K, et al. Sentinel node mapping guided by indocyanine green fluorescence imaging during laparoscopic surgery in gastric cancer[J]. Ann Surg Oncol, 2010, 17(7):1787-1793.
22.	Lee SE, Lee JH, Ryu KW, et al. Sentinel node mapping and skip metastases in patients with early gastric cancer[J]. Ann Surg Oncol, 2009, 16(3):603-608.
23.	Takeuchi H, Kitagawa Y. Sentinel node navigation surgery in patients with early gastric cancer[J]. Dig Surg, 2013, 30(2): 104-111.
24.	Wang Z, Dong ZY, Liu JL, et al. Diagnostic value of sentinel lymph node biopsy in gastric cancer:a meta-analysis[J]. Ann Surg Oncol, 2012, 19(5):1541-1550.
25.	Tonouchi H, Mohri Y, Kobayashi M, et al. Laparoscopy-assisted distal gastrectomy with laparoscopic sentinel lymph node biopsy after endoscopic mucosal resection for early gastric cancer[J]. Surg Endosc, 2007, 21(8):1289-1293.
26.	Miyashiro I, Hiratsuka M, Sasako M, et al. High false-negative proportion of intraoperative histological examination as a serious problem for clinical application of sentinel node biopsy for early gastric cancer:final results of the Japan Clinical Oncology Group multicenter trial JCOG0302[J]. Gastric Cancer, 2014, 17(2): 316-323.
27.	Lee HS, Lee HE, Park do J, et al. Precise pathologic examination decreases the false-negative rate of sentinel lymph node biopsy in gastric cancer[J]. Ann Surg Oncol, 2012, 19(3):772-778.

1. Ahn JY, Jung HY. Long-term outcome of extended endoscopic submucosal dissection for early gastric cancer with differentiated histology[J]. Clin Endoc, 2013, 46(5):463-466.
2. Omae M, Fujisaki J, Horiuchi Y, et al. Safety, efficacy, and long-term outcomes for endoscopic submucosal dissection of early esophagogastric junction cancer[J]. Gastric Cancer, 2013, 16(2):147-154.
3. Abe S, Oda I, Suzuki H, et al. Short-and long-term outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer[J]. Endoscopy, 2013, 45(9):703-707.
4. 许啸声, 郑民华.前哨淋巴结活检在早期胃癌淋巴结转移评估中的作用[J].外科理论与实践, 2010, 15(2):194-196.
5. 陈秀峰, 张波, 杨弘鑫, 等.早期胃癌前哨淋巴结的临床研究[J].四川大学学报:医学版, 2013, 44(1):151-154.
6. Rothbarth J, Wijnhoven BP. Lymphatic dissemination and the role of sentinel lymph node biopsy in early gastric cancer[J]. Dig Surg, 2012, 29(2):130-131.
7. 内镜黏膜下剥离术专家协作组.消化道黏膜病变内镜黏膜下剥离术治疗专家共识[J].中华胃肠外科杂志, 2012, 15(10): 1083-1086.
8. Washington K. 7^th of the AJCC cancer staging manual:stomach[J]. Ann Surg Oncol, 2010, 17(12):3077-3079.
9. Nam BH, Kim YW, Reim D, et al. Laparoscopy assisted versus open distal gastrectomy with D2 lymph node dissection for advanced gastric cancer:design and rationale of a phaseⅡrandomized controlled multicenter trial (COACT 1001)[J]. J Gastric Cancer, 2013, 13(3):164-171.
10. 徐均, 董永红, 赵宝玉, 等.腹腔镜辅助下远端胃癌D2清扫入路的临床分析[J].中华胃肠外科杂志, 2012, 15(12): 1269-1272.
11. 唐波, 余佩武.腹腔镜胃癌D2手术淋巴结清扫原则与技巧[J].中国普外基础与临床杂志, 2011, 18(2):114-115.
12. Son SY, Park JY, Ryu KW, et al. The risk factors for lymph node metastasis in early gastric cancer patients who underwent endoscopic resection:is the minimal lymph node dissection applicable? A retrospective study[J]. Surg Endosc, 2013, 27(9): 3247-3253.
13. 周平红, 张轶群.胃肠道早期癌的内镜粘膜下剥离术治疗[J].中华临床医师杂志:电子版, 2012, 6(21):6627-6629.
14. Chiu PW, Teoh AY, To KF, et al. Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia:a retrospective cohort study[J]. Surg Endosc, 2012, 26(12):3584-3591.
15. Yasunaga H, Horiguchi H, Kuwabara K, et al. Outcomes after laparoscopic or open distal gastrectomy for early-stage gastric cancer:a propensity-matched analysis[J]. Ann Surg, 2013, 257(4):640-646.
16. 余佩武.腹腔镜胃癌手术的进展与展望[J].中国普外基础与临床杂志, 2011, 18(2):105-109.
17. Choi MK, Kim GH, Park do Y, et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer:a single-center experience[J]. Surg Endosc, 2013, 27(11):4250-4258.
18. Leong SP, Kim J, Ross M, et al. A phase 2 study of 99Tcmtilmanocept in the detection of sentinel lymph nodes in melanoma and breast cancer[J]. Ann Surg Oncol, 2011, 18(4):961-969.
19. Quan ML, McCready D. The evolution of lymph node assessment in breast cancer[J]. J Surg Oncol, 2009, 99(4):194-198.
20. Jones EL, Jones TS, Pearlman NW, et al. Long-term follow-up and survival of patients following a recurrence of melanoma after a negative sentinel lymph node biopsy result[J]. JAMA Surg, 2013, 148(5):456-461.
21. Tajima Y, Murakami M, Yamazaki K, et al. Sentinel node mapping guided by indocyanine green fluorescence imaging during laparoscopic surgery in gastric cancer[J]. Ann Surg Oncol, 2010, 17(7):1787-1793.
22. Lee SE, Lee JH, Ryu KW, et al. Sentinel node mapping and skip metastases in patients with early gastric cancer[J]. Ann Surg Oncol, 2009, 16(3):603-608.
23. Takeuchi H, Kitagawa Y. Sentinel node navigation surgery in patients with early gastric cancer[J]. Dig Surg, 2013, 30(2): 104-111.
24. Wang Z, Dong ZY, Liu JL, et al. Diagnostic value of sentinel lymph node biopsy in gastric cancer:a meta-analysis[J]. Ann Surg Oncol, 2012, 19(5):1541-1550.
25. Tonouchi H, Mohri Y, Kobayashi M, et al. Laparoscopy-assisted distal gastrectomy with laparoscopic sentinel lymph node biopsy after endoscopic mucosal resection for early gastric cancer[J]. Surg Endosc, 2007, 21(8):1289-1293.
26. Miyashiro I, Hiratsuka M, Sasako M, et al. High false-negative proportion of intraoperative histological examination as a serious problem for clinical application of sentinel node biopsy for early gastric cancer:final results of the Japan Clinical Oncology Group multicenter trial JCOG0302[J]. Gastric Cancer, 2014, 17(2): 316-323.
27. Lee HS, Lee HE, Park do J, et al. Precise pathologic examination decreases the false-negative rate of sentinel lymph node biopsy in gastric cancer[J]. Ann Surg Oncol, 2012, 19(3):772-778.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Endoscopic Submucosal Dissection Combined Laparoscopic Sentinel Lymph Node Biopsy for Early Gastric Cancer:A Report of 26 Cases

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