Fluorescent Navigation Surgery for Gastrointestinal Tract Cancers: Detection of Sentinel Nodes, Tumor Tattooing, and Harvesting of Lymph Nodes

Kusano, Mitsuo; Ono, Hiromi; Danjo, Yasushi; Kawamata, Futoshi; Tajima, Yusuke; Ohtsubo, Seiji; Shimada, Shingo; Koyanagi, Kaname

doi:10.1007/978-4-431-55528-5_14

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…The most promising method is the fat-dissociation method (113), which has been reported to be useful for shortening the time and improving the accuracy of node harvesting in patients with gastric cancer. Other methods such as indocyanine green fluorescence and methylene blue staining methods have also been proposed (141,142).…”

Section: Current State and Future Developments In The Evaluation Of Lymph Node Metastasis In Gastric Cancermentioning

confidence: 99%

Significance of Lymph Node Metastasis in the Treatment of Gastric Cancer and Current Challenges in Determining the Extent of Metastasis

2022

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The stomach exhibits abundant lymphatic flow, and metastasis to lymph nodes is common. In the case of gastric cancer, there is a regularity to the spread of lymph node metastasis, and it does not easily metastasize outside the regional nodes. Furthermore, when its extent is limited, nodal metastasis of gastric cancer can be cured by appropriate lymph node dissection. Therefore, identifying and determining the extent of lymph node metastasis is important for ensuring accurate diagnosis and appropriate surgical treatment in patients with gastric cancer. However, precise detection of lymph node metastasis remains difficult. Most nodal metastases in gastric cancer are microscopic metastases, which often occur in small-sized lymph nodes, and are thus difficult to diagnose both preoperatively and intraoperatively. Preoperative nodal diagnoses are mainly made using computed tomography, although the specificity of this method is low because it is mainly based on the size of the lymph node. Furthermore, peripheral nodal metastases cannot be palpated intraoperatively, nodal harvesting of resected specimens remains difficult, and the number of lymph nodes detected vary greatly depending on the skill of the technician. Based on these findings, gastrectomy with prophylactic lymph node dissection is considered the standard surgical procedure for gastric cancer. In contrast, several groups have examined the value of sentinel node biopsy for accurately evaluating nodal metastasis in patients with early gastric cancer, reporting high sensitivity and accuracy. Sentinel node biopsy is also important for individualizing and optimizing the extent of uniform prophylactic lymph node dissection and determining whether patients are indicated for function-preserving curative gastrectomy, which is superior in preventing post-gastrectomy symptoms and maintaining dietary habits. Notably, advancements in surgical treatment for early gastric cancer are expected to result in individualized surgical strategies with sentinel node biopsy. Chemotherapy for advanced gastric cancer has also progressed, and conversion gastrectomy can now be performed after downstaging, even in cases previously regarded as inoperable. In this review, we discuss the importance of determining lymph node metastasis in the treatment of gastric cancer, the associated difficulties, and the need to investigate strategies that can improve the diagnosis of lymph node metastasis.

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Section: Current State and Future Developments In The Evaluation Of Lymph Node Metastasis In Gastric Cancermentioning

confidence: 99%

Significance of Lymph Node Metastasis in the Treatment of Gastric Cancer and Current Challenges in Determining the Extent of Metastasis

2022

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“…ICG tattooing method is very useful for the marking of early gastric and CCs, especially when using a laparoscopic approach[ 181 ]. It has been suggested that SLN mapping with fluorescent dye can play an important role in the treatment of CC, particularly those at early stages, and can lead to ultraconservative surgery[ 182 ].…”

Section: The Osna Assay For the Detection Of Crc Metastasis In Slnmentioning

confidence: 99%

Role of one-step nucleic acid amplification in colorectal cancer lymph node metastases detection

Crafa¹,

Vanella²,

Catalano³

et al. 2022

WJG

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Current histopathological staging procedures in colorectal cancer (CRC) depend on midline division of the lymph nodes (LNs) with one section of hematoxylin and eosin staining. Cancer cells outside this transection line may be missed, which could lead to understaging of Union for International Cancer Control Stage II high-risk patients. The one-step nucleic acid amplification (OSNA) assay has emerged as a rapid molecular diagnostic tool for LN metastases detection. It is a molecular technique that can analyze the entire LN tissue using a reverse-transcriptase loop-mediated isothermal amplification reaction to detect tumor-specific cytokeratin 19 mRNA. Our findings suggest that the OSNA assay has a high diagnostic accuracy in detecting metastatic LNs in CRC and a high negative predictive value. OSNA is a standardized, observer-independent technique, which may lead to more accurate staging. It has been suggested that in stage II CRC, the upstaging can reach 25% and these patients can access postoperative adjuvant chemotherapy. Moreover, intraoperative OSNA sentinel node evaluation may allow early CRC to be treated with organ-preserving surgery, while in more advanced-stage disease, a tailored lymphadenectomy can be performed considering the presence of aberrant lymphatic drainage and skip metastases.

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Fluorescent Navigation Surgery for Gastrointestinal Tract Cancers: Detection of Sentinel Nodes, Tumor Tattooing, and Harvesting of Lymph Nodes

Cited by 2 publications

References 16 publications

Significance of Lymph Node Metastasis in the Treatment of Gastric Cancer and Current Challenges in Determining the Extent of Metastasis

Significance of Lymph Node Metastasis in the Treatment of Gastric Cancer and Current Challenges in Determining the Extent of Metastasis

Role of one-step nucleic acid amplification in colorectal cancer lymph node metastases detection

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