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Sentinel Node Navigation Surgery for Early Gastric Cancer: Analysis of Factors Which Affect Direction of Lymphatic Drainage

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Abstract

Background and purpose

We started performing sentinel node navigation surgery (SNNS) for patients with early gastric cancer (EGC) using infrared ray electronic endoscopy (IREE) with indocyanine green injection from year 2000. The EGCs usually have complex lymphatic drainage, unidirectional or multidirectional lymphatic flow. In this study, we investigated and clarified factors that affect the direction of gastric lymphatic drainage.

Patients and method

Consecutive 60 patients with EGC who underwent SNNS by IREE from year 2006 to 2014 were enrolled to this study. Patients’ age, gender, location of tumors, operative method, previous treatment by endoscopic submucosal dissection (ESD), presence of pathological ulcerative scar and maximum tumor diameter were enrolled as parameters which may affect direction of lymphatic drainage and analyzed.

Result

Bivariate analysis demonstrated that the presence of pathological ulcerative scar (P = 0.01), tumor location (g.c vs. a.w vs. p.w vs. l.c, P = 0.01), and maxim tumor diameter (P = 0.0003) were relevant to direction of gastric lymphatic drainage. Multivariate analysis showed that tumor location (g.c/a.w/p.w vs. l.c, odds ratio 8.227, P = 0.011) and the maximum tumor diameter (odds ratio 1.057, P = 0.037) are independent factors that affect direction of gastric lymphatic flow. Of tumors, 78% located at lesser curvature had unidirectional lymphatic drainage, and 93% of tumors whose diameter was 40 mm and more had multidirectional lymphatic drainage.

Conclusion

Our investigation revealed that the tumor location and tumor diameter were the key factors which affect the direction of lymphatic drainage, which is useful fact to understand the complexity of gastric lymphatic drainage.

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References

  1. Jemal A, Siegel R, Ward E et al (2009) Cancer statistics, 2009. CA Cancer J Clin 59(4):225–249

    Article  PubMed  Google Scholar 

  2. Parkin DM, Bray F, Ferlay J et al (2005) Global cancer statistics, 2002. CA Cancer J Clin 55(2):74–108

    Article  PubMed  Google Scholar 

  3. Nimura H, Narimiya N, Mitsumori N et al (2004) Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer. Br J Surg 91:575–579

    Article  CAS  PubMed  Google Scholar 

  4. Ohdaira H, Nimura H, Mitsumori N et al (2007) Validity of modified gastrectomy combined with sentinel node navigation surgery for early gastric cancer. Gastric Cancer 10:117–122

    Article  PubMed  Google Scholar 

  5. Kelder W, Nimura H, Takahashi N et al (2010) Sentinel node mapping with indocyanine green (ICG) and infrared ray detection in early gastric cancer: an accurate method that enables a limited lymphadenectomy. Eur J Surg Oncol 36:552–558

    Article  CAS  PubMed  Google Scholar 

  6. Yano K, Nimura H, Mitsumori N et al (2012) The efficiency of micrometastasis by sentinel node navigation surgery using indocyanine green and infrared ray laparoscopy system for gastric cancer. Gastric Cancer 15:287–291

    Article  PubMed  Google Scholar 

  7. Mitsumori N, Nimura H, Takahashi N et al (2009) Sentinel node navigation surgery for early malignant tumor of the duodenum. Jikeikai Med J 56:11–17

    Google Scholar 

  8. Shida A, Mitsumori N, Nimura H et al (2016) Prediction of lymph node metastasis and sentinel node navigation surgery for patients with early-stage gastric cancer. World J Gastroenterol 22(33):7431–7439

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shida A, Fujioka S, Kawamura M et al (2014) Prediction of lymph node metastasis in patients with submucosa-invading early gastric cancer. Anticancer Res 34(8):4471–4474

    PubMed  Google Scholar 

  10. Miwa K, Kinami S, Taniguchi K et al (2003) Mapping sentinel nodes in patients with early-stage gastric carcinoma. Br J Surg 90(2):178–182

    Article  CAS  PubMed  Google Scholar 

  11. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112

    Article  Google Scholar 

  12. Kawamura M, Nakada K, Konishi H et al (2014) Assessment of motor function of the remnant stomach by 13C breath test with special reference to gastric local resection. World J Surg 38(11):2898–2903. doi:10.1007/s00268-014-2660-6

    Article  PubMed  Google Scholar 

  13. Morton DL, Wen DR, Wong JH et al (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 127:392–399

    Article  CAS  PubMed  Google Scholar 

  14. Veronesi U, Paganelli G, Viale G et al (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349:546–553

    Article  PubMed  Google Scholar 

  15. Kitagawa Y, Takeuchi H, Takagi Y et al (2013) Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol 31:3704–3710

    Article  PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Atsuo Shida, Norio Mitsumori, Shuichi Fujioka, Yuta Takano, Muneharu Fujisaki, Ryosuke Hashizume, Naoto Takahashi, Yoshio Ishibashi & Katsuhiko Yanaga

Authors
  1. Atsuo Shida
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  2. Norio Mitsumori
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  3. Shuichi Fujioka
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  4. Yuta Takano
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  5. Muneharu Fujisaki
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  6. Ryosuke Hashizume
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  7. Naoto Takahashi
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  8. Yoshio Ishibashi
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  9. Katsuhiko Yanaga
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Corresponding author

Correspondence to Atsuo Shida.

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None of the authors has any conflict of interest regarding the manuscript.

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Shida, A., Mitsumori, N., Fujioka, S. et al. Sentinel Node Navigation Surgery for Early Gastric Cancer: Analysis of Factors Which Affect Direction of Lymphatic Drainage. World J Surg 42, 766–772 (2018). https://doi.org/10.1007/s00268-017-4226-x

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  • DOI: https://doi.org/10.1007/s00268-017-4226-x

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