title: Validity of modified gastrectomy combined with sentinel node navigation surgery for early gastric cancer.
abstract: BACKGROUND
  The present study examined the clinical validity of modified gastrectomy for early gastric cancer, in terms of the results of sentinel node navigation surgery (SNNS), using infrared ray electronic endoscopy (IREE) plus indocyanine green (ICG) staining.
  
  
  METHODS
  One-hundred and sixty-one patients with fT1N0 gastric cancer were enrolled in the study. ICG (0.5 ml, 5 mg/ml) was injected endoscopically into four quadrants of the submucosa surrounding the cancer. Twenty minutes after the injection, sentinel lymph nodes (SNs) stained with ICG were observed intraperitoneally around the serosa and surrounding fat tissue. IREE was used to illuminate regional lymph nodes from the serosal side.
  
  
  RESULTS
  Group 2 lymph nodes were judged as SNs in 52 patients (32%). The most common locations of the SNs were stations No. 7 in each of the upper-, middle-, and lower-thirds of the stomach. In two patients, lymph node metastasis was positive. One of these patients, with cancer in the middle one-third of the stomach, had SNs in stations No. 3, 4sb, 4d, 7, and No. 11p, and had metastatic lymph nodes in No. 3 and No. 7 (all SNs). The other patient, with cancer in the lower one-third of the stomach, had SNs in No. 1, 3, 4d, and 6, and had a metastatic lymph node in No. 4d (SN). Skip metastasis was not observed in this study, and metastatic lymph nodes were judged to have been dissected by the D1+a procedure.
  
  
  CONCLUSIONS
  For T1N0 gastric cancer, modified gastrectomy (D1+a dissection) combined with SNNS is suitable; however, for those whose Group 2 lymph nodes are judged to be SNs, additional dissection of lymphatic basins detected by SNNS should be performed to confirm the absence of lymph node metastasis.
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Tokyo, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Ohdaira
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nimura
authors.forename: Norio
authors.initials: N
authors.lastname: Mitsumori
authors.forename: Naoto
authors.initials: N
authors.lastname: Takahashi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kashiwagi
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D004396:Coloring Agents; D005260:Female; D005743:Gastrectomy; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green; D007259:Infrared Rays; D008198:Lymph Nodes / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D013055:Spectrophotometry, Infrared / Q000379:methods; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green