J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 3580KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 101(3): 315-319, 2000

Feature topic

THE VALIDITY OF THE SENTINE NODE CONCEPT IN GASTROINTESTINAL CANCERS

1) Department of Surgery, Keio University School of Medicine, Tokyo, Japan
2) Department of Radiology, Keio University School of Medicine, Tokyo, Japan
3) Department of Pathology, Keio University School of Medicine, Tokyo, Japan

Yuko Kitagawa1), Hirofumi Fujii2), Makio Mukai3), Nobutoshi Ando1), Tetsuo Kubota1), Tadashi Ikeda1), Masahiro Ohgami1), Masahiko Watanabe1), Yoshihide Otani1), Soji Ozawa1), Hirotoshi Hasegawa1), Toshiharu Furukawa1), Tadaki Nakahara2), Atsushi Kubo2), Koichiro Kumai1), Masaki Kitajima1)

Although the sentinel node concept has been validated and clinically applied to breast cancer and malignant melanoma, its clinical significance in other solid tumors has not been thoroughly investigated. With regard to gastrointestinal (GI) cancers in particular, our surgeons have been cautious because of the high frequency of skip metastasis and the complicated lymphatic system in the GI tract. We would like to emphasize that so-called skip metastasis has been defined according to anatomic classification of regional lymph nodes and that the lymphatic drainage route must be patient or lesion specific. To test the validity and feasibility of this concept in GI cancers, we have established a radio-guided intraoperative sentinel node navigation system using preoperative endoscopic submucosal injection of radioactive tracer followed by intra-operative gammaprobing. In 131 patients with GI cancers (esophagus : 22, stomach : 71, colorectum : 38), the detection rate of sentinel nades was 91% and overall diagnostic accuracy of iymph node metastasis by sentinel node status was 97%. Initial results suggest further investigation of this procedure as an accurate staging and a minimally invasive approach to early GI cancers.

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