As an optimal surgical procedure to accurately evaluate lymph node (LN) metastasis during surgery with minimal surgical resection, we have been developing sentinel node (SN) biopsy for early gastric cancer since the 1990s. Twelve institutions from the Japanese Society of Sentinel Node Navigation Surgery (SNNS), including Keio University Hospital, conducted a multicenter prospective trial to validate the SN concept using the dual-tracer method with blue dye and a radioisotope. According to the results, 397 patients were included in the final analysis, and the overall accuracy in detecting LN metastasis using SN biopsy was 99% (383 of 387). Based on the validation study, we are targeting cT1N0 with a primary tumor of ≤4 cm in diameter as an indication for SN biopsy for gastric cancer. We are currently running a multicenter nonrandomized phase III trial to assess the safety and efficacy of SN navigation surgery. The Korean group has reported the result of a multicenter randomized phase III trial. Since meticulous gastric cancer in the remnant stomach was rescued by subsequent gastrectomy, the disease-specific survival was comparable between the two techniques, implying that SN navigation surgery can be an alternative to standard gastrectomy. With the development of SN biopsy procedure and treatment modalities, the application of SN biopsy will be expanded to achieve an individualized minimally invasive surgery.
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机译:作为在手术期间准确评估淋巴结(LN)转移的最佳外科手术,从20世纪90年代以来,我们一直在为早期胃癌开发Sentinel节点(Sn)活组织检查。来自日本的Sentinel节点导航手术(SNNS)的十二个机构,包括Keio University Hospital,进行了多中心的前瞻性试验,以使用蓝染料和放射性同位素的双跟踪方法验证SN概念。根据结果,在最终分析中包含397名患者,使用Sn活检检测LN转移的总体精度为99%(383个中的387个)。基于验证研究,我们靶向CT1N0,其直径≤4厘米的主要肿瘤是胃癌Sn活检的指示。我们目前正在运行多中心非粗化第三阶段试验,以评估SN导航手术的安全性和功效。韩国集团报告了多中心随机阶段审判的结果。由于随后的胃切除术来拯救残留胃中的细致胃癌,因此两种技术之间的疾病特异性存活率迫切然是SN导航手术可以是标准胃切除术的替代方案。随着SN活检程序和治疗方式的发展,将扩大Sn活检的应用以实现个性化的微创手术。
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