2012 Volume 45 Issue 3 Pages 243-249
Introduction: Many reports on sentinel node (SN) navigation surgery in gastric cancer patients have been presented and have evaluated different tracers and injection methods. We studied the combined use of fluorescent beads with a particle diameter closer to that of a cancer cell than other tracers and dye (indocyanine green; ICG) to detect SN. Methods: Subjects were 31 patients with cN0 gastric cancer who gave prior written consent to participate in this study. One day before surgery, we injected fluorescent beads into the submucosal layer around the primary lesion endoscopically. During surgery, ICG was injected into the subserosal space from the serosal side surrounding the primary lesion. After ICG injection, a green SN was detected within 15 minutes. Ultraviolet irradiation was used for extracted lymph nodes and fluoresent nodes were assumed to be SNs. Results: In combined bead/dye injection, SN detection in early gastric cancer was 92% (23/25), in fluorescent beads alone 76% (19/25), and in ICG alone 60% (15/25). The mean number of SNs was 2.3 in all 3 procedures. SNs were detected in 7 cases in which both tracers were used. SNs with fluorescent beads were detected in lymph nodes of both the first and second compartments. Conclusions: SN detection increased in combined bead/dye injection, but it was difficult to detect fluorescent lymph nodes hidden in adipose tissue during surgery due to tissue autofluorescence.
