title: Sentinel lymph node navigation surgery for pancreatic head cancers.
abstract: Recently, sentinel lymph node (SN) concept has been validated for gastrointestinal and breast cancers. Our previous study has shown that the No. 13 posterior pancreaticoduodenal lymph node group constitutes the major regional drainage site from primary tumors in the pancreatic head, and that the status of these nodes predicts that of the No. 16 abdominal paraaortic lymph node group. Based on these results, we have developed SN navigation surgery for pancreatic cancer, in the search for more curable and less invasive surgery. In brief, 2% patent blue dye is injected into the peritumoral area. Approximately 5 min later, one or more blue-stained nodes within the area of the No. 13 lymph node group are identified and excised for intraoperative frozen section examination. The subsequent surgical decision-tree is as follows: i) if No. 13 SNs are negative, an extended No. 16 lymph node dissection is not performed to reduce morbidity, and ii) when cancer is found, the No. 16 lymph nodes are dissected completely. Since July 1997, nine of 21 patients scheduled to undergo an extended curative surgery underwent SN biopsy. SNs within the area of the No. 13 lymph node group were identified in 8 (89%) patients. An extended No. 16 lymph node dissection was avoided in 4 SN-negative patients. The overall 3-year survival rate of the 21 patients was 36%, and 4 patients (three SN-negative and one SN-positive patients) with stage IVa disease were alive 3 years after surgery. Three SN-negative patients underwent an extended curative pylorus-preserving pancreaticoduodenectomy (PpPD) with combined portal vein resection, but without an extended No. 16 dissection. In conclusion, SN biopsy and curative PpPD can increase curability, reduce morbidity, and provide long-term survival in patients with locally advanced pancreatic head cancer as an alternative to routine extended No. 16 lymph node dissection.
authors.affiliation: Department of Gastroenterologic Surgery, Kanazawa University Hospital, Kanazawa 920-0934, Japan. ohtat@surg2.m.kanazawa-u.ac.jp
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ohta
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Kitagawa
authors.forename: Masato
authors.initials: M
authors.lastname: Kayahara
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Kinami
authors.forename: Itasu
authors.initials: I
authors.lastname: Ninomiya
authors.forename: Sachio
authors.initials: S
authors.lastname: Fushida
authors.forename: Takashi
authors.initials: T
authors.lastname: Fujimura
authors.forename: Gen-ichi
authors.initials: G
authors.lastname: Nishimura
authors.forename: Koichi
authors.initials: K
authors.lastname: Shimizu
authors.forename: Shuangqin
authors.initials: S
authors.lastname: Yi
authors.forename: Koichi
authors.initials: K
authors.lastname: Miwa
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy