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ORIGINAL ARTICLE
Year : 2016  |  Volume : 12  |  Issue : 5  |  Page : 57-59

Application value of sentinel lymph node biopsy in the radical operation for Stage II advanced gastric cancer


1 Department of General Surgery, Henan University Huaihe Hospital, Henan, Kaifeng 475000, PR China
2 Department of Emergency, Henan University Huaihe Hospital, Henan, Kaifeng 475000, PR China

Date of Web Publication7-Oct-2016

Correspondence Address:
Xuequn Ren
Department of General Surgery, Henan University Huaihe Hospital, Henan, Kaifeng 475000
PR China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.191632

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 > Abstract 


Objective: This study aims to explore the application value of sentinel lymph node (SLN) biopsy in patients with Stage II advanced gastric cancer and its effects on prognosis.
Materials and Methods: A total of 43 patients with Stage II gastric cancer (experimental group) admitted to our department from March 2011 to February 2013 underwent radical operation using SLN biopsy, and 51 patients with gastric cancer D2 (the control group) received conventional radical operation. The operation time, intraoperative blood loss, number of lymph nodes dissected, postoperative complications, and length of hospital stay between the two groups of patients were recorded. Their clinical data were retrospectively analyzed.
Results: The operation times of the experimental group and that of the control group patients were, respectively, 199.6 ± 38.7 and 143.8 ± 33.6 min, with statistical difference (P < 0.05). The number of lymph nodes dissected in the experimental group (18.2 ± 0.8) was significantly greater than that of the control group (13.8 ± 0.7) (P < 0.05). No difference in statistical significance in the intraoperative blood loss (150.2 ± 33.6 vs. 143.8 ± 39.4 mL) or length of stay (12.3 ± 2.6 vs. 11.8 ± 3.1 days) was found between the two groups (P > 0.05). The 2-year survival rates of the experimental group after surgery and that of the control group were 83.7% and 72.5%, respectively, with statistical difference (P < 0.05).
Conclusions: Compared with conventional radical gastrectomy, Stage II SLN biopsy on the premise that neither the intraoperative blood loss nor the length of hospital stay increases can improve the 2-year survival.

Keywords: Clinical efficacy, gastric cancer, sentinel lymph node biopsy


How to cite this article:
Xie Y, Li F, Ren X. Application value of sentinel lymph node biopsy in the radical operation for Stage II advanced gastric cancer. J Can Res Ther 2016;12:57-9

How to cite this URL:
Xie Y, Li F, Ren X. Application value of sentinel lymph node biopsy in the radical operation for Stage II advanced gastric cancer. J Can Res Ther [serial online] 2016 [cited 2018 Nov 16];12:57-9. Available from: http://www.cancerjournal.net/text.asp?2016/12/5/57/191632




 > Introduction Top


Sentinel lymph node (SLN) refers to the first lymph node draining cancer and involving micrometastases.[1],[2] The application of the SLN in the operation for early gastric cancer has been reported in much literature. However, most patients with gastric cancer have been developed into the advanced stage at the time of diagnosis. Stage II SLN (SSLN), which was first suggested in 2007 based on SSLN biopsy, is applied to the SSL tracer injection for advanced gastric cancer, obtaining SLN by marking distant lymph node in metastasis.[3],[4] Thus, very few reports on the application of the SSLN biopsy in advanced gastric cancer are available. In the current study, the clinical data of patients admitted to our department from March 2011 to February 2013, including 43 cases who underwent the radical operation for gastric cancer combined with SSLN biopsy and 51 cases who received the conventional D2 radical operation for gastric cancer, were collected. The cases were analyzed retrospectively, and the feasibility and application value of SSLN biopsy in advanced gastric cancer were explored.


 > Materials and Methods Top


General information

The clinical data of 94 patients admitted to our department with advanced gastric cancer from March 2011 to February 2013, who underwent gastroscopy combined with mucosal biopsy after being pathologically confirmed and examined by computed tomography and B-ultrasound, were retrospectively analyzed. Among the patients, 43 cases underwent radical gastrectomy combined with SSLN biopsy and 51 cases received conventional D2 radical gastrectomy. Inclusion criteria were (1) highly or moderately differentiated gastric cancer as confirmed by preoperative biopsy;[5] (2) tumor size <3 cm; (3) surrounding tissues not involved as revealed by preoperative examination; (4) no distant metastasis as revealed by preoperative imaging; and (5) relatively complete postoperative follow-up data. The experimental group patients consisted of 43 patients, including 28 males and 15 females (age of 56.2 ± 12.1 years on average), and the control group was composed of 51 patients (31 males and 20 females), with an average age of 57.0 ± 14.6 years. No statistically significant difference in age, pathological type, or staging was found between the two groups (P > 0.05) [Table 1].
Table 1: The general information of the two groups

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Surgical procedures

Both radical gastrectomy combined with SSLN biopsy and conventional D2 radical operation for gastric cancer were undertaken by the same group of surgeons. Disposable surgical staples and sutures were provided by the same manufacturer. In the former group, a 20 cm incision was cut in the middle of the upper abdomen of the patient in supine position. Distant-proximal abdominal exploration was performed in accordance with the tumor-free principles after reaching the abdominal cavity layer, and the primary tumor was probed. Methylene blue reagent was injected along the surrounding mucosa of the primary tumor. About 1 mL was injected every injection point. At 6–8 min after injection, several blue-stained lymphatic vessels run from the primary tumor, extending far along the lesser and greater curvatures of the stomach. The blue-stained lymph node, i.e., the SLN, could be detected along the blue-stained band. The SLN was collected, labeled, and sent for quick freezing and examination. The methylene blue reagent was injected around the SLN with positive results. The blue-stained band extended far, and the blue-stained lymph node, i.e., the SSLN, could be found along the blue-stained band. The gathered SSLN was sent for quick freezing and slicing, and the lymph nodes around the gastric cancer were selectively removed according to the results.[6] The lymph node in the region with negative SSLN results received only the D2 surgery whereas those with positive results underwent D3 or D4 surgery. In the latter group, a 20 cm incision was cut in the middle of the upper abdomen of the patient in supine position under general anesthesia. After reaching the abdominal cavity layer, conventional excision was performed as required by the D2 radical gastrectomy.


 > Results Top


Intraoperative and postoperative results comparison

The operation time of the experimental and control group patients was 199.6 ± 38.7 and 143.8 ± 33.6 min, respectively, and the former was significantly greater than the latter (P < 0.05). The number of lymph nodes dissected in the experimental group (18.2 ± 0.8) was significantly greater than that of the control group (13.8 ± 0.7) (P < 0.05). No difference in statistical significance in intraoperative blood loss (150.2 ± 33.6 vs. 143.8 ± 39.4 mL) or length of stay (12.3 ± 2.6 vs. 11.8 ± 3.1 days) was found between the two groups (P > 0.05) [Table 2].
Table 2: Intra-and post-operative results comparison

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Follow-up

The 2-year survival rates of the experimental group after surgery and that of the control group were 83.7% and 72.5%, respectively, and the former was significantly higher than the latter (P < 0.05).


 > Discussion Top


Gastric cancer is the most common gastrointestinal cancer in China whereas advanced gastric cancer is the dominant gastric cancer.[7],[8] The standard surgical regime for gastric cancer is D2 surgery. Currently, clinicians often have the following two tendencies in radical gastrectomy: (1) for the large extent of lymphadenectomy, patients with advanced gastric cancer often receive D3–D4 surgery, with nonmetastatic lymph nodes and/or tissues excised; thus, surgical difficulty increases exponentially with more postoperative complications and poorer life after surgery; and (2) given that the extent of resection is not large enough, metastatic lymph nodes remain, quickly leading to postoperative recurrence. Therefore, determining the dissection and category of lymph node rationally for every patient is the research direction of gastric cancer and also the difficulty in gastric surgery.[1],[9] Currently, the application of the SLN biopsy in treating early gastric cancer has been already accepted by majority of scholars. However, for advanced gastric cancer with larger tumor size, a series of problems, such as high false positive/negative rate, is caused by blocked draining lymphatic vessels, thus restricting the application of SLN biopsy in treating advanced gastric cancer.[10] However, with the further study of SLN biopsy, a new idea on the application of SLN biopsy in treating advanced gastric cancer, i.e., SSLN biopsy, has surfaced. Advanced gastric cancer does not mean the metastasis of every group of lymph nodes. Therefore, any excessive resection of nonmetastatic lymph nodes and tissues is avoided. Late lymphatic metastasis of different surgery patients should be mastered. Studies have shown that for advanced gastric cancer, SSLN biopsy can not only reveal the law of metastasis of lymph nodes involving advanced gastric cancer but also allow the individualized surgical regime based on the specific circumstances of patients by understanding their late lymphatic metastasis. In the present study, SSLN biopsy is first applied clinically with intraoperative lymphatic metastasis and regular dissection in the region with positive results of quick freezing and slicing of SSLN (instead that with negative results). The results show that the individualized surgical regime with SSLN biopsy does not increase any risk of surgery, and this surgery is statistically different from the conventional D2 radical operation for gastric cancer in the 2-year survival rate after surgery (P < 0.05), and the 2-year survival rate after surgery of the former is significantly higher. Thus, this technique is safe and feasible, and using staining tracer, the SLN can be intuitively observed with simple operation and low cost, without special requirements in equipment or pollution.

However, the sampling size for retrospective clinical analysis in the present study is small, and the between-group balance is poor and prone to information biases. Thus, prospective controlled trials will be conditionally conducted to further assess the application value of the SSLN biopsy in treating advanced gastric cancer.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

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Kitagawa Y, Fujii H, Mukai M, Kubo A, Kitajima M. Sentinel lymph node mapping in esophageal and gastric cancer. Cancer Treat Res 2005;127:123-39.  Back to cited text no. 1
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Kitagawa Y, Fujii H, Mukai M, Kubota T, Ando N, Ozawa S, et al. Intraoperative lymphatic mapping and sentinel lymph node sampling in esophageal and gastric cancer. Surg Oncol Clin N Am 2002;11:293-304.  Back to cited text no. 2
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Takeuchi H, Kitagawa Y. Sentinel lymph node biopsy in gastric cancer. Cancer J 2015;21:21-4.  Back to cited text no. 3
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Mitsumori N, Nimura H, Takahashi N, Kawamura M, Aoki H, Shida A, et al. Sentinel lymph node navigation surgery for early stage gastric cancer. World J Gastroenterol 2014;20:5685-93.  Back to cited text no. 4
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Mahmoud W, Sukhanova A, Oleinikov V, Rakovich YP, Donegan JF, Pluot M, et al. Emerging applications of fluorescent nanocrystals quantum dots for micrometastases detection. Proteomics 2010;10:700-16.  Back to cited text no. 5
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Tong JH, Sun Z, Wang ZN, Zhao YH, Huang BJ, Li K, et al. Early gastric cancer with signet-ring cell histologic type: Risk factors of lymph node metastasis and indications of endoscopic surgery. Surgery 2011;149:356-63.  Back to cited text no. 6
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Zhao EH, Ling TL, Cao H. Current status of surgical treatment of gastric cancer in the era of minimally invasive surgery in China: Opportunity and challenge. Int J Surg 2016;28:45-50.  Back to cited text no. 7
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Xu L, Pan Q, Lin R. Prevalence rate and influencing factors of preoperative anxiety and depression in gastric cancer patients in China: Preliminary study. J Int Med Res 2016;44:377-88.  Back to cited text no. 8
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Lips DJ, Schutte HW, van der Linden RL, Dassen AE, Voogd AC, Bosscha K. Sentinel lymph node biopsy to direct treatment in gastric cancer. A systematic review of the literature. Eur J Surg Oncol 2011;37:655-61.  Back to cited text no. 9
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Tóth D, Kincses Z, Plósz J, Török M, Kovács I, Kiss C, et al. Value of sentinel lymph node mapping using a blue dye-only method in gastric cancer: A single-center experience from North-East Hungary. Gastric Cancer 2011;14:360-4.  Back to cited text no. 10
    



 
 
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