title: Secondary sentinel lymph node tracing technique: a new method for tracing lymph nodes in radical gastrectomy for advanced gastric cancer.
abstract: 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.
authors.affiliation: Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sichuan Medical University, Luzhou 646000, China.
authors.forename: Zong-lin
authors.initials: ZL
authors.lastname: Li
authors.affiliation: Department of Gastrointestinal Surgery, the Second Affiliated Hospital of North Sichuan Medical College, Mianyang 621000, China.
authors.forename: Huai-wu
authors.initials: HW
authors.lastname: Jiang
authors.affiliation: Department of Laboratory Medicine, the First Affiliated Hospital of Sichuan Medical University, Luzhou 646000, China.
authors.forename: Min
authors.initials: M
authors.lastname: Song
authors.affiliation: Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sichuan Medical University, Luzhou 646000, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sichuan Medical University, Luzhou 646000, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Xia
authors.affiliation: Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sichuan Medical University, Luzhou 646000, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Advanced gastric cancer (AGC); Individual lymphadenectomy; Secondary sentinel lymph node (SSLN); Survival analysis