Download PDF
Endoscopy 2007; 39(5): 471-475
DOI: 10.1055/s-2007-966432
Innovation forum

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic treatment combined with laparoscopic sentinel node mapping for superficial gastrointestinal cancers

Y.  Kitagawa1 , M.  Kitajima1
  • 1Department of Surgery, Keio University, School of Medicine, Tokyo, Japan
Further Information

Publication History

Publication Date:
22 May 2007 (online)

Also available at
    Permissions and Reprints

Endoscopic mucosal resection (EMR) has been established as a minimally invasive treatment for mucosal gastrointestinal cancer with no risk of lymph node metastasis. Recent advances in endoscopic technologies and devices, including the development of endoscopic submucosal dissection (ESD), have improved local control of superficial gastrointestinal cancer. Novel technologies in endoscopic treatments allow us to resect wider and deeper gastrointestinal cancer lesions. A current major limitation of EMR/ESD is the risk of micrometastasis in regional lymph nodes. To resolve this issue, attention has been focused on the concept of sentinel nodes. The first possible sites of metastasis along the lymphatic drainage route from the primary lesion are known as sentinel nodes. In the past 5 years, a number of single-center studies have been published that support the validity of the sentinel node concept for gastrointestinal cancers. The combination of EMR/ESD and laparoscopic/thoracoscopic sentinel node mapping seems to be a breakthrough that can extend the indication for the endoscopic treatment of gastrointestinal cancers with a potential risk of lymph node metastasis. Although there are several technical obstacles to overcome, this strategy has great potential in the near future as a novel minimally invasive treatment for superficial gastrointestinal cancers.

References

  • 1 Hiki Y, Shimao H, Mieno H. et al . Modified treatment of early gastric cancer: evaluation of endoscopic treatment of early gastric cancers with respect to treatment indication groups.  World J Surg. 1995;  19 517-522
    CrossrefPubMedGoogle Scholar
  • 2 Imaeda H, Iwao Y, Ogata H. et al .A new technique for endoscopic submucosal dissection for early gastric cancer using an external grasping forceps. Endoscopy 2006 PMID: 16 673 308 (Epub)
    Google Scholar
  • 3 Fujihiro M, Yahagi N, Kakushima N. et al . En bloc resection of a large semicircular esophageal cancer by endoscopic submucosal dissection.  Surg Laparosc Endosc Percutan Tech. 2006;  16 237-241
    CrossrefPubMedGoogle Scholar
  • 4 Gotoda T. Endoscopic resection of early gastric cancer: the Japanese perspective.  Curr Opin Gastroenterol. 2006;  22 561-569
    CrossrefPubMedGoogle Scholar
  • 5 Morton D L, Wen D R, Wong J H. et al . Technical details of intraoperative lymphatic mapping for early stage melanoma.  Arch Surg. 1992;  127 392-399
    CrossrefPubMedGoogle Scholar
  • 6 Kitagawa Y, Fujii H, Mukai M. et al . The role of sentinel lymph nodes in gastrointestinal cancer.  Surg Clin N Am. 2000;  80 1799-1809
    CrossrefPubMedGoogle Scholar
  • 7 Saha S, Seghal R, Patel M. et al . A multicenter trial of sentinel lymph node mapping in colorectal cancer: prognostic implications for nodal staging and recurrence.  Am J Surg. 2006;  191 305-310
    CrossrefPubMedGoogle Scholar
  • 8 Bilchik A J, DiNome M, Saha S. et al . Prospective multicenter trial of staging adequacy in colon cancer: preliminary results.  Arch Surg. 2006;  141 527-533
    PubMedGoogle Scholar
  • 9 Hiratsuka M, Miyashiro I, Ishikawa O. et al . Application of sentinel node biopsy to gastric cancer surgery.  Surgery. 2001;  129 335-340
    CrossrefPubMedGoogle Scholar
  • 10 Yasuda S, Shimada H, Ogoshi K. et al . Preliminary study for sentinel lymph node identification with Tc-99 m tin colloid in patients with esophageal or gastric cancer.  Tokai J Exp Clin Med. 2001;  26 15-18
    PubMedGoogle Scholar
  • 11 Ichikura T, Morita D, Uchida T. et al . Sentinel node concept in gastric carcinoma.  World J Surg. 2002;  26 318-322
    CrossrefPubMedGoogle Scholar
  • 12 Kitagawa Y, Fujii H, Mukai M. et al . Radio-guided sentinel node detection for gastric cancer.  Br J Surg. 2002;  89 604-608
    CrossrefPubMedGoogle Scholar
  • 13 Carlini M, Carboni F, Petric M. et al . Sentinel node in gastric cancer surgery.  J Exp Clin Cancer Res. 2002;  21 469-473
    PubMedGoogle Scholar
  • 14 Hayashi H, Ochiai T, Mori M. et al . Sentinel lymph node mapping for gastric cancer using a dual procedure with dye- and gamma probe-guided techniques.  J Am Coll Surg. 2003;  196 68-74
    CrossrefPubMedGoogle Scholar
  • 15 Miwa K, Kinami S, Taniguchi K. et al . Mapping sentinel nodes in patients with early-stage gastric carcinoma.  Br J Surg. 2003;  90 178-182
    CrossrefPubMedGoogle Scholar
  • 16 Gretschel S, Bembenek A, Ulmer C h. et al . Lymphatic mapping and sentinel lymph node biopsy in gastric cancer.  Chirurg. 2003;  74 132-138
    CrossrefPubMedGoogle Scholar
  • 17 Yasuda S, Shimada H, Chino O. et al . Sentinel lymph node detection with Tc-99 m tin colloids in patients with esophagogastric cancer.  Jpn J Clin Oncol. 2003;  33 68-72
    CrossrefPubMedGoogle Scholar
  • 18 Tonouchi H, Mohri Y, Tanaka K. et al . Lymphatic mapping and sentinel node biopsy during laparoscopic gastrectomy for early cancer.  Dig Surg. 2003;  20 421-427
    CrossrefPubMedGoogle Scholar
  • 19 Simsa J, Hoch J, Leffler J. et al . Sentinel node biopsy in gastric cancer: preliminary results.  Acta Chir Belg. 2003;  103 270-273
    PubMedGoogle Scholar
  • 20 Ryu K W, Lee J H, Kim H S. et al . Prediction of lymph nodes metastasis by sentinel node biopsy in gastric cancer.  Eur J Surg Oncol. 2003;  29 895-899
    CrossrefPubMedGoogle Scholar
  • 21 Song X, Wang L, Chen W. et al . Lymphatic mapping and sentinel node biopsy in gastric cancer.  Am J Surg. 2004;  187 270-273
    CrossrefPubMedGoogle Scholar
  • 22 Kim M C, Jung G J, Lee J H. et al . Lymph node biopsy with 99mTc tin colloid in patients with gastric carcinoma.  Hepatogastroenterology. 2003;  50 (Suppl 2) ccxiv-ccxv
    PubMedGoogle Scholar
  • 23 Nimura H, Narimiya N, Mitsumori N. et al . Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer.  Br J Surg. 2004;  91 575-579
    CrossrefPubMedGoogle Scholar
  • 24 Karube T, Ochiai T, Shimada H. et al . Detection of sentinel lymph nodes in gastric cancers based on immunohistochemical analysis of micrometastases.  J Surg Oncol. 2004;  87 32-38
    CrossrefPubMedGoogle Scholar
  • 25 Kim M C, Kim H H, Jung G J. et al . Lymphatic mapping and sentinel node biopsy using 99mTc tin colloid in gastric cancer.  Ann Surg. 2004;  239 383-387
    PubMedGoogle Scholar
  • 26 Osaka H, Yashiro M, Sawada T. et al . Is a lymph node detected by the dye-guided method a true sentinel node in gastric cancer?.  Clin Cancer Res. 2004;  10 6912-6918
    CrossrefPubMedGoogle Scholar
  • 27 Uenosono Y, Natsugoe S, Ehi K. et al . Detection of sentinel nodes and micrometastases using radioisotope navigation and immunohistochemistry in patients with gastric cancer.  Br J Surg. 2005;  92 886-889
    CrossrefPubMedGoogle Scholar
  • 28 Zulfikaroglu B, Koc M, Ozmen M M. et al . Intraoperative lymphatic mapping and sentinel lymph node biopsy using radioactive tracer in gastric cancer.  Surgery. 2005;  138 899-904
    CrossrefPubMedGoogle Scholar
  • 29 Park D J, Lee H J, Lee H S. et al . Sentinel node biopsy for cT1 and cT2a gastric cancer.  Eur J Surg Oncol. 2006;  32 48-54
    CrossrefPubMedGoogle Scholar
  • 30 Ishizaki M, Kurita A, Kubo Y. et al . Evaluation of sentinel node identification with isosulfan blue in gastric cancer.  Eur J Surg Oncol. 2006;  32 191-196
    CrossrefPubMedGoogle Scholar
  • 31 Rabin I, Chikmen B, Halpern Z. et al . Sentinel node mapping for gastric cancer.  Isr Med Assoc J. 2006;  8 40-43
    PubMedGoogle Scholar
  • 32 Mochiki E, Kuwano H, Kamiyama Y. et al . Sentinel lymph node mapping with technetium-99 m colloidal rhenium sulfide in patients with gastric carcinoma.  Am J Surg. 2006;  191 465-469
    CrossrefPubMedGoogle Scholar
  • 33 Lee J H, Ryu K W, Kim C G. et al . Sentinel node biopsy using dye and isotope double tracers in early gastric cancer.  Ann Surg Oncol. 2006;  13 1168-74
    CrossrefPubMedGoogle Scholar
  • 34 Rino Y, Takanashi Y, Harada H. et al .Technique and assessment of sentinel lymph node biopsy usefulness in laparoscopy-assisted distal gastrectomy. Surg Endosc 2006 Oct 5 [Epub ahead of print]
    Google Scholar
  • 35 Heuts E M, vanderEnt F W, Kengen R A. et al . Results of sentinel node biopsy not affected by previous excisional biopsy.  Eur J Surg Oncol. 2006;  32 278-281
    CrossrefPubMedGoogle Scholar
  • 36 Natsugoe S, Okumura H, Matsumoto M. et al . Individualization of lymphadenectomy in superficial esophageal squamous cell cancer.  Esophagus. 2006;  3 41-45
    CrossrefPubMedGoogle Scholar
  • 37 Kitagawa Y, Fujii H, Kumai K. et al . Recent advances in sentinel node navigation for gastric cancer - A paradigm shift of surgical management.  J Surg Oncol. 2005;  90 147-151
    CrossrefPubMedGoogle Scholar
  • 38 Kitagawa Y, Kitajima M. Diagnostic validity of radio-guided sentinel node mapping for gastric cancer - a review of current status and future direction.  Surg Technol Int. 2006;  15 32-36
    PubMedGoogle Scholar
  • 39 Kitagawa Y, Kitajima M. Laparoscopic sentinel lymph node mapping for early gastric cancer.  World J Surg. 2005;  29 416-417
    CrossrefPubMedGoogle Scholar
  • 40 Matsuda J, Kitagawa Y, Fujii H. et al . Significance of metastasis detected by molecular techniques in sentinel nodes of patients with gastrointestinal cancer.  Ann Surg Oncol. 2004;  11 250S-254S
    PubMedGoogle Scholar

Y. Kitagawa, MD, PhD 

Department of Surgery
Keio University School of Medicine

35 Shinanomachi, Shinjuku-ku
Tokyo, 160-8582
Japan

Fax: +81-3-33554707

Email: kitagawa@sc.itc.keio.ac.jp

      >