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Secondary sentinel lymph node tracing technique: a new method for tracing lymph nodes in radical gastrectomy for advanced gastric cancer

Li, Zong-lin, Jiang, Huai-wu, Song, Min, Xu, Liang, Xia, Dong, Liu, Qing
Journal of Zhejiang University 2015 v.16 no.11 pp. 897-903
biopsy, lymph nodes, metastasis, methodology, methylene blue, patients, stomach neoplasms, survival rate, China
OBJECTIVE: To explore the feasibility and clinical value of secondary sentinel lymph node (SSLN) tracing technique in radical gastrectomy for advanced gastric cancer (AGC). METHODS: From January 2009 to June 2011, 247 patients who suffered from gastric angle cancer with metastasis in No. 3 group lymph nodes were divided randomly into groups A and B. Methylthioninium chloride was injected into the peripheral tissue of the metastatic No. 3 group lymph nodes of 138 patients in group A before tumor resections. SSLNs were traced and individual lymphadenectomies were carried out based on the biopsy results of the SSLNs. Standard D2 radical gastrectomies were carried out directly on 109 patients in group B. Postoperative follow-up and survival analysis were carried out for patients in both groups. RESULTS: SSLNs were found in 114 (82.6%) patients in group A. Ninety of those patients (78.9%) demonstrated existing metastasis in SSLNs. According to Kaplan-Meier’s method, the postoperative 3-year cumulative survival rates were 63.5% and 47.5%, and the median survival time were 40 and 36 months for the patients of groups A and B, respectively (P<0.05). CONCLUSIONS: The SSLN tracing technique is feasible in radical gastrectomy for AGC. It gives surgeons important information about the terminal status of lymph node metastasis and provides some scientific basis for individual lymphadenectomy.