Abstract
Background
This study aimed to evaluate the technical feasibility and safety of laparoscopic partial full-thickness gastrectomy with extensive sentinel node basin (SB) dissection in a porcine model before its application to gastric cancer without lymph node metastasis.
Methods
A series of 10 pigs (30–37 kg) were used for a survival study approved by an animal use committee. The imaginary lesions were located in the greater curvature (n = 2), lesser curvature (n = 2), anterior wall (n = 2), posterior wall (n = 2), cardia (n = 1), and angle of the stomach (n = 1). The SBs were assumed to be located around each lesion in question. Laparoscopic partial gastrectomy and SB dissection were performed. Upper gastrointestinal series (UGIS) studies were performed with gastrograffin 5 days after the operation to detect possible stricture, leakage, and passage problems. The pigs were kept alive for 3 weeks, then killed.
Results
The procedure was completed for all the pigs. Nine gastric wedge resections and one segmental resection of the stomach with several SB dissections were performed. The mean operation time was 102 min (70–150 min). The postoperative mean weight gain was 3.19 kg. There was no perioperative morbidity or mortality. The UGIS studies failed to detect leakage and stricture, but all the pigs exhibited delayed gastric emptying. Necropsies did not detect procedure-related complications.
Conclusions
As shown by a pig model, laparoscopic limited gastrectomy with SB dissection appears to be safe and technically feasible.
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References
Gould EA, Winship T, Philbin Ph, Kerr HH (1960) Observations on “sentinel lymph node” in cancer of the parotid. Cancer 13:77–78
Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, Foshag LJ, Cochran AJ (1993) Technique details of intraoperative lymphatic mapping for early-stage melanoma. Arch Surg 127:392–399
Alex KC, Weaver D, Faorbaml KT, Ramlom Bs, Lrag DM (1993) Gamma-probe-guided lymph node localization in malignant melanoma. Surg Oncol 2:303–308
Hiratsuka M, Miyashiro I, Ishikawa O, Furukawa H, Motomura K, Ohigashi H, Kameyama M, Sasaki Y, Kabuto T, Ishiguro S, Imaoka S, Koyama H (2001) Application of sentinel node biopsy to gastric cancer surgery. Surgery 129:335–340
Kitagawa Y, Fujii H, Mukai M, Kubota T, Otani Y, Kitajima M (2001) Radio-guided sentinel node detection for gastric cancer. Br J Surg 89:604–608
Hayashi H, Ochiai T, Mori M, Karube T, Suzuki T, Gunji Y, Hori S, Akutsu N, Matsubara H, Shimada H (2003) Sentinel lymph node mapping for gastric cancer using a dual procedure with dye- and gamma-probe-guided techniques. J Am Coll Surg 196:68–74
Kim MC, Kim HH, Jung GJ, Lee JH, Choi SR, Kang DY, Roh MS, Jeong JS (2004) Lymphatic mapping and sentinel node biopsy using 99 mTc tin colloid in gastric cancer. Ann Surg 239:383–387
Park DJ, Lee HJ, Lee HS, Kim WH, Kim HH, Lee KU, Choe KJ, Yang HK (2006) Sentinel node biopsy for cT1 and cT2a gastric cancer. Eur J Surg Oncol 32:48–54
Ajisaka H, Miwa K (2003) Micrometastasis in sentinel nodes of gastric cancer. Br J Cancer 89:676–680
Miwa K, Kinami S, Taniguchi K, Fushida S, Fujimura T, Nonomura A (2003) Mapping sentinel nodes in patients with early-stage gastric carcinoma. Br J Surg 90:178–182
Mochiki E, Kuwano H, Kamiyama Y, Aihara R, Nakabayashi T, Katoh H, Asao T, Oriuchi N, Endo K (2006) Sentinel lymph node mapping with technetium-99 m colloidal rhenium sulfide in patients with gastric carcinoma. Am J Surg 191:465–469
Lee JH, Ryu KW, Kook MC, Lee JY, Kim CG, Choi IJ, Kim SK, Jang S, Park SR, Kim YW, Nam BH, Bae JM (2008) Feasibility of laparoscopic sentinel basin dissection for limited resection in early gastric cancer. J Surg Oncol 98:331–335
Skoropad V, Berdow B, Zagrebin V (2005) Clinicopathological features and outcome of surgical treatment of 149 patients with early (pT1) gastric cancer. Oncologie 28:247–252
Gotoda T (2007) Endoscopic resection of early gastric cancer. Gastric Cancer 10:1–11
Ohgami M, Otani Y, Kumai K, Kubota T, Kim YI, Kitajima M (1999) Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg 23:187–193
Yasuda K, Shiraishi N, Suematsu T, Yamaguchi K, Adachi Y, Kitano S (1999) Rate of detection of lymph node metastasis is correlated with the depth of submucosal invasion in early-stage gastric carcinoma. Cancer 85:2119–2123
Tonouch H, Mohri Y, Tanaka K, Kobayashi M, Ohmori Y, Kusunoki M (2005) Laparoscopic lymphatic mapping and sentinel node biopsies for early-stage gastric cancer: the cause of false negativity. World J Surg 29:418–421
Aoyagi N, Ogata H, Kaniwa N, Uchiyama M, Yasuda Y, Tanioka Y (1992) Gastric emptying of tablets and granules in humans, dogs, pigs, and stomach-emptying controlled rabbits. J Pharm 8:1170–1174
Hossain M, Abramowitz W, Watrous BJ, Szpunar GJ, Ayres JW (1990) Gastrointestinal transit of nondisintegrating, nonerodible oral dosage forms in pigs. Pharm Res 7:1163–1166
Acknowledgment
This study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A085125).
Disclosures
Ju-Hee Lee, Moon-Soo Lee, Hyung Ho Kim, Do Joong Park, Kyoung Ho Lee, Ji-Yeon Hwang, Hyuk-Joon Lee, Han-Kwang Yang and Kuhn Uk Lee have no conflicts of interest or financial ties to disclosure.
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Lee, JH., Lee, M.S., Kim, HH. et al. Feasibility of Laparoscopic partial gastrectomy with sentinel node basin dissection in a porcine model. Surg Endosc 25, 1070–1075 (2011). https://doi.org/10.1007/s00464-010-1318-1
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DOI: https://doi.org/10.1007/s00464-010-1318-1