Use of a lead shield for laparoscopic detection of the sentinel lymph nodes in gastric cancer

Abstract

Background: Accurate staging of lymph node metastasis by sentinel node biopsy is easily achieved in conventional open gastric surgery. Staging is not easily achieved in laparoscopic surgery, however, because of the technical difficulty in identifying sentinel nodes. We developed a laparoscopic method that involves lead shielding for detection of sentinel nodes in gastric cancer and examined the efficacy of this method. Methods: Laparoscopic sentinel node biopsy was performed in 18 patients with early gastric cancer. A combined dye-and radio-guided method was used in the first 10 patients; our radio-guided lead shield method was used in the subsequent eight cases. Laparoscopy-assisted distal gastrectomy was performed in all patients, and dissected nodes were examined by routine hematoxylin and eosin staining. The detection rate was compared between the two groups. Results: The detection rate for sentinel nodes was higher with the radio-guided lead shield method (88%) than with the combined dye-and radio-guided method (40%). Regional lymph node metastasis was recognized in one of 18 patients, and the sentinel node was positive in this case. Conclusions: Use of a lead shield is beneficial for accurate laparoscopic detection of sentinel lymph nodes.

Diagnostic value of near‐infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta‐analysis

“…Similarly, Wang et al did not obtain a satisfactory result: a higher pooled identification rate and sensitivity in laparotomy but a higher pooled accuracy rate and negative predictive value in laparoscopy . Therefore, more studies are needed to confirm if there are any exaggerated merits of open surgery when combined with dye‐guided detection or overcritical drawbacks of laparoscopic surgery while combined with radio‐guided procedures in previous studies …”

“…41 Therefore, more studies are needed to confirm if there are any exaggerated merits of open surgery when combined with dye-guided detection or overcritical drawbacks of laparoscopic surgery while combined with radio-guided procedures in previous studies. 46,[94][95][96] Previous studies reported that, even with an FN SLN, metastatic non-SLN was always situated in the same SLN basin in GC. 95,[97][98][99][100] Therefore, the LBD seemed safer than the pick-up method, and it should be proposed as a standard technique to detect nodal metastases.…”

Systematic Review of Studies Investigating Sentinel Node Navigation Surgery and Lymphatic Mapping for Gastric Cancer

“…Japan (5) Isozaki et al 17 Prospective Clinical (6) South Korea (1) Nimura et al 18 Prospective Kim et al 19 Prospective Tanaka et al 20 Prospective Yasuda et al 21 Prospective Osaka et al 22 Prospective 2005…”

“…In 9 (21%) of those 43 studies, the authors adopted laparoscopic or laparoscopic-assisted procedures. 16,21,23,34,37,42,46,47,53 The remaining four (9%) studies were constructed with amalgamated patient subsets of open and laparoscopic treatment. 18,35,49,55 It is unsurprising that reports from the early 2000s show that attempts of SNNS at that time were undertaken during open surgery.…”