Application of Subserosal Injection of Carbon Nanoparticle Lymphatic Tracer in Laparo-scopic Assisted Radical Gastrectomy for Advanced Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHENGKe ,  ZHUANGJing , LIBao-dong , LIUYong-gang , WANGJin-bang , LIDan , FENGWei-yu , XUDong-li , ZHANGHui-liang

Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, Henan Province, China;

Corresponding?author：

ZHUANGJing, Email: 13383817858@189.cn

Keywords：

Carbon nanoparticle; Lymph node; Tracer; Laparoscopic assisted radical gastrectomy

DOI：

10.7507/1007-9424.20160370

Video：

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Objective To investigate the applicated value of carbon nanoparticle lymphatic tracer in laparoscopic assisted radical gastrectomy for advanced gastric cancer. Methods Forty-two patients with advanced gastric cancer who were admitted to the Department of General Surgery in The Affiliated Cancer Hospital of Zhengzhou University from March to September in 2014, were collected prospectively and randomly divided into two groups (carbon nanoparticle group and control group), each group enrolled in 21 cases. After improving relevant auxiliary inspection, subserosal injection of carbon nanoparticle around the tumor was performed via venous infusion needle laparoscopically at the beginning of surgery in carbon nanoparticle group, while the patients routinely underwent laparoscopic assisted radical gastrectomy in control group. Comparison of the results of harvested lymph nodes and its detection time between the two groups was performed, and the perioperative complications were also evaluated. Results A total of 678 lymph nodes were detected in carbon nanoparticle group and 447 lymph nodes were detected in control group. The number of harvested lymph nodes in carbon nanoparticle group (32.28±4.10) was significantly higher than that of control group (21.28±2.74), P < 0.05. The mean harvest time in carbon nanoparticle group was shorter than that of control group[(24.09± 3.58) min vs. (32.76±4.76) min, P < 0.05]. The proportion of harvested small lymph node (≤5 mm) in carbon nanoparticle group was higher than that of control group[71.68% (486/678) vs. 48.99% (219/447), P < 0.01]. The number of black-dyed harvested lymph node was 506 (74.63%) and the metastasis rate of black-dyed lymph node was 26.28% (133/506) in carbon nanoparticle group, that the metastasis rate of black-dyed lymph node group was significantly higher than those of without black-dyed lymph node group[6.40% (11/172)] and control group[19.24% (86/447)], P < 0.05. No serious side effect caused by carbon nanoparticle was observed. Conclusions The application of diluted carbon nanoparticle lymphatic tracer has a good effect in the dissection of lymph nodes in laparoscopic assisted radical gastrectomy for advanced gastric cancer. It improves the detection rate of lymph nodes, especially the small lymph nodes, and it is safe and feasible.

Citation： CHENGKe, ZHUANGJing, LIBao-dong, LIUYong-gang, WANGJin-bang, LIDan, FENGWei-yu, XUDong-li, ZHANGHui-liang. Application of Subserosal Injection of Carbon Nanoparticle Lymphatic Tracer in Laparo-scopic Assisted Radical Gastrectomy for Advanced Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(12): 1460-1463. doi: 10.7507/1007-9424.20160370 Copy

1.	梁寒.局部進展期胃癌合理淋巴結清掃范圍再探討.中國腫瘤臨床, 2016, 43(1):11-14.
2.	Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma:3rd English edition. Gastric Cancer, 2011, 14(2):101-112.
3.	陳峻青.深刻理解新版日本胃癌"處理規約"和"治療指南"提高我國胃癌治療水平.中國實用外科雜志, 2010, 30(8):621-624.
4.	黎煥君, 劉琦, 陳志良, 等.淋巴結轉移率對胃癌D2根治術患者的預后分析.腫瘤學雜志, 2016, 22(4):300-304.
5.	Zhang J, Zhou Y, Jiang K, et al. Evaluation of the seventh AJCC TNM staging system for gastric cancer:a meta-analysis of cohort studies. Tumor Biol, 2014, 35(9):8525-8532.
6.	陳鴻源, 王亞楠, 薛芳沁, 等.腹腔鏡下靜脈輸液針注射法納米碳淋巴示蹤技術在胃癌根治術中的應用.中華胃腸外科雜志, 2014, 17(5):457-460.
7.	余佩武, 羅華星.腹腔鏡胃癌根治術:未來治療胃癌的標準手術.第三軍醫大學學報, 2013, 35(18):1889-1892.
8.	Noh SH, Park SR, Yang HK, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC):5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol, 2014, 15(12):1389-1396.
9.	Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med, 2007, 357(18):1810-1820.
10.	Qu JL, Li X, Qu XJ, et al. Optimal duration of fluorouracil-based adjuvant chemotherapy for patients with resectable gastric cancer. PLoS One, 2013, 8(12):e83196.
11.	Sasako M, Sakuramoto S, Katai H, et al. Five-year outcomes of a randomized phase Ⅲ trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage Ⅱ or Ⅲ gastric cancer. J Clin Oncol, 2011, 29(33):4387-4393.
12.	Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxali-platin for gastric cancer after D2 gastrectomy (CLASSIC):a phase 3 open-label, randomised controlled trial. Lancet, 2012, 379(9813):315-321.
13.	林曉生.胃癌淋巴結微轉移的研究進展.世界最新醫學信息文摘, 2016, 16(4):41.
14.	Alatengbaolide, Lin D, Li Y, et al. Lymph node ratio is an independent prognostic factor in gastric cancer after curative resection (R0) regardless of the examined number of lymph nodes. Am J Clin Oncol, 2013, 36(4):325-330.
15.	Degiuli M, Sasako M, Ponti A, et al. Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg, 2010, 97(5):643-649.
16.	王晨曦, 張軍.胃癌原發灶與胃鏡活檢標本及淋巴結轉移灶中Her-2狀態的比較.中國腫瘤臨床, 2014, 41(3):184-188.
17.	耿宏智, 劉兵, 徐藝可, 等.影響進展期胃癌淋巴結轉移率分期和轉移數量分期的病理因素.中華胃腸外科雜志, 2013, 16(4):358-362.
18.	Son T, Hyung WJ, Lee JH, et al. Clinical implication of an insufficient number of examined lymph nodes after curative resection for gastric cancer. Cancer, 2012, 118(19):4687-4693.
19.	Jiao XG, Deng JY, Zhang RP, et al. Prognostic value of number of examined lymph nodes in patients with node-negative gastric cancer. World J Gastroenterol, 2014, 20(13):3640-3648.
20.	陳海寧, 張波, 陳秀峰, 等.納米炭在胃癌根治術中的臨床應用研究.中國普外基礎與臨床雜志, 2011, 18(2):149-152.
21.	Okamoto K, Sawai K, Minato H, et al. Number and anatomical extent of lymph node metastases in gastric cancer:analysis using intra-lymph node injection of activated carbon particles (CH40). Jpn J Clin Oncol, 1999, 29(2):74-77.
22.	蘇向前, 邢加迪.示蹤技術在胃癌診治中的應用.中國實用外科雜志, 2005, 25(7):392-394.
23.	Yoshida K, Ohta K, Ohhashi I, et al. Studies on gastric lymphatics by using activated carbon particle (CH44) and lymph node metastasis of gastric cancer. Nihon Geka Gakkai Zasshi, 1988, 89(5):664-670.
24.	謝萍, 謝永美, 宋鑫, 等.親水性接枝納米炭的制備及其淋巴靶向特性的研究.華西藥學雜志, 2006, 21(4):337-339.
25.	李佰營, 王直, 姬生威, 等.納米碳示蹤技術在胃癌根治術中的應用.現代腫瘤醫學, 2012, 20(8):1673-1674.
26.	Mieog JS, Troyan SL, Hutteman M, et al. Toward optimization of imaging system and lymphatic tracer for near-infrared fluorescent sentinel lymph node mapping in breast cancer. Ann Surg Oncol, 2011, 18(9):2483-2491.

1. 梁寒.局部進展期胃癌合理淋巴結清掃范圍再探討.中國腫瘤臨床, 2016, 43(1):11-14.
2. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma:3rd English edition. Gastric Cancer, 2011, 14(2):101-112.
3. 陳峻青.深刻理解新版日本胃癌"處理規約"和"治療指南"提高我國胃癌治療水平.中國實用外科雜志, 2010, 30(8):621-624.
4. 黎煥君, 劉琦, 陳志良, 等.淋巴結轉移率對胃癌D2根治術患者的預后分析.腫瘤學雜志, 2016, 22(4):300-304.
5. Zhang J, Zhou Y, Jiang K, et al. Evaluation of the seventh AJCC TNM staging system for gastric cancer:a meta-analysis of cohort studies. Tumor Biol, 2014, 35(9):8525-8532.
6. 陳鴻源, 王亞楠, 薛芳沁, 等.腹腔鏡下靜脈輸液針注射法納米碳淋巴示蹤技術在胃癌根治術中的應用.中華胃腸外科雜志, 2014, 17(5):457-460.
7. 余佩武, 羅華星.腹腔鏡胃癌根治術:未來治療胃癌的標準手術.第三軍醫大學學報, 2013, 35(18):1889-1892.
8. Noh SH, Park SR, Yang HK, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC):5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol, 2014, 15(12):1389-1396.
9. Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med, 2007, 357(18):1810-1820.
10. Qu JL, Li X, Qu XJ, et al. Optimal duration of fluorouracil-based adjuvant chemotherapy for patients with resectable gastric cancer. PLoS One, 2013, 8(12):e83196.
11. Sasako M, Sakuramoto S, Katai H, et al. Five-year outcomes of a randomized phase Ⅲ trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage Ⅱ or Ⅲ gastric cancer. J Clin Oncol, 2011, 29(33):4387-4393.
12. Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxali-platin for gastric cancer after D2 gastrectomy (CLASSIC):a phase 3 open-label, randomised controlled trial. Lancet, 2012, 379(9813):315-321.
13. 林曉生.胃癌淋巴結微轉移的研究進展.世界最新醫學信息文摘, 2016, 16(4):41.
14. Alatengbaolide, Lin D, Li Y, et al. Lymph node ratio is an independent prognostic factor in gastric cancer after curative resection (R0) regardless of the examined number of lymph nodes. Am J Clin Oncol, 2013, 36(4):325-330.
15. Degiuli M, Sasako M, Ponti A, et al. Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg, 2010, 97(5):643-649.
16. 王晨曦, 張軍.胃癌原發灶與胃鏡活檢標本及淋巴結轉移灶中Her-2狀態的比較.中國腫瘤臨床, 2014, 41(3):184-188.
17. 耿宏智, 劉兵, 徐藝可, 等.影響進展期胃癌淋巴結轉移率分期和轉移數量分期的病理因素.中華胃腸外科雜志, 2013, 16(4):358-362.
18. Son T, Hyung WJ, Lee JH, et al. Clinical implication of an insufficient number of examined lymph nodes after curative resection for gastric cancer. Cancer, 2012, 118(19):4687-4693.
19. Jiao XG, Deng JY, Zhang RP, et al. Prognostic value of number of examined lymph nodes in patients with node-negative gastric cancer. World J Gastroenterol, 2014, 20(13):3640-3648.
20. 陳海寧, 張波, 陳秀峰, 等.納米炭在胃癌根治術中的臨床應用研究.中國普外基礎與臨床雜志, 2011, 18(2):149-152.
21. Okamoto K, Sawai K, Minato H, et al. Number and anatomical extent of lymph node metastases in gastric cancer:analysis using intra-lymph node injection of activated carbon particles (CH40). Jpn J Clin Oncol, 1999, 29(2):74-77.
22. 蘇向前, 邢加迪.示蹤技術在胃癌診治中的應用.中國實用外科雜志, 2005, 25(7):392-394.
23. Yoshida K, Ohta K, Ohhashi I, et al. Studies on gastric lymphatics by using activated carbon particle (CH44) and lymph node metastasis of gastric cancer. Nihon Geka Gakkai Zasshi, 1988, 89(5):664-670.
24. 謝萍, 謝永美, 宋鑫, 等.親水性接枝納米炭的制備及其淋巴靶向特性的研究.華西藥學雜志, 2006, 21(4):337-339.
25. 李佰營, 王直, 姬生威, 等.納米碳示蹤技術在胃癌根治術中的應用.現代腫瘤醫學, 2012, 20(8):1673-1674.
26. Mieog JS, Troyan SL, Hutteman M, et al. Toward optimization of imaging system and lymphatic tracer for near-infrared fluorescent sentinel lymph node mapping in breast cancer. Ann Surg Oncol, 2011, 18(9):2483-2491.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of Subserosal Injection of Carbon Nanoparticle Lymphatic Tracer in Laparo-scopic Assisted Radical Gastrectomy for Advanced Gastric Cancer

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