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Review
. 2014 May 21;20(19):5685-93.
doi: 10.3748/wjg.v20.i19.5685.

Sentinel lymph node navigation surgery for early stage gastric cancer

Norio Mitsumori  1 , Hiroshi Nimura  1 , Naoto Takahashi  1 , Masahiko Kawamura  1 , Hiroaki Aoki  1 , Atsuo Shida  1 , Nobuo Omura  1 , Katsuhiko Yanaga  1
Affiliations
Review

Sentinel lymph node navigation surgery for early stage gastric cancer

Norio Mitsumori et al. World J Gastroenterol. .

Abstract

We attempted to evaluate the history of sentinel node navigation surgery (SNNS), technical aspects, tracers, and clinical applications of SNNS using Infrared Ray Electronic Endoscopes (IREE) combined with Indocyanine Green (ICG). The sentinel lymph node (SLN) is defined as a first lymph node (LN) which receives cancer cells from a primary tumor. Reports on clinical application of SNNS for gastric cancers started to appear since early 2000s. Two prospective multicenter trials of SNNS for gastric cancer have also been accomplished in Japan. Kitagawa et al reported that the endoscopic dual (dye and radioisotope) tracer method for SN biopsy was confirmed acceptable and effective when applied to the early-stage gastric cancer (EGC). We have previously reported the usefulness of SNNS in gastrointestinal cancer using ICG as a tracer, combined with IREE (Olympus Optical, Tokyo, Japan) to detect SLN. LN metastasis rate of EGC is low. Hence, clinical application of SNNS for EGC might lead us to avoid unnecessary LN dissection, which could preserve the patient's quality of life after operation. The most ideal method of SNNS should allow secure and accurate detection of SLN, and real time observation of lymphatic flow during operation.

Keywords: Gastric cancer; Indocyanine Green; Infrared Ray Electronic Endoscopes; Sentinel node navigation surgery.

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Figures

Figure 1
Figure 1
Laparoscopic observation around the left gastric vessels (LN No.3,7). Lymph vessels and LN can be easily detected by IREE with Indocyanine Green (ICG). A: Ordinary light observation of lymph vessels around the left gastric artery; B: Infrared ray observation of lymph vessels around left gastric region (Lymph vessels: arrow; ICG positive node: arrowhead); C: Ordinary light observation of lymph vessels around the right epigastric artery; D: Infrared ray observation around the right epigastric artery shows first drainage lymph vessels, and sentinel lymph node (SLN) (arrow); E: Ordinary light observation of lymph vessels; F: Infrared ray observation of lymph vessels (first drainage lymph vessels: arrow; SLN: arrowhead).
Figure 2
Figure 2
Mechanism of absorption with indocyanine green and fluorescence from indocyanine green. Irradiated with light near the maximum absorption wavelength, the ICG-injected area in the tissue absorbs the light and becomes darker. In the other areas in the background, the light is reflected and those areas become brighter. ICG: Indocyanine Green.
Figure 3
Figure 3
Wavelength of the indocyanine green. Indocyanine green (ICG) has a maximum 805 nm of absorption wavelength. Absorption wavelength band of ICG: Red line; Fluorescence wavelength band of ICG: Blue line.
Figure 4
Figure 4
Technological overview of the new infrared observation system ordinary light and infrared ray laparoscopy system can be changed by a handle switch.
See this image and copyright information in PMC

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