Research progress of assisted techniques for lymph node dissection in gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DING Tianlong ^1,2 , XU Bo ¹ , WANG Yunpeng ¹ , ZHANG Jing ¹ , WANG Haiyun ¹ , HE Puyi ¹ , ZHU Jingyu ¹ ,  CHEN Hao ^2,3

1. Lanzhou University Second School of Clinical Medicine, Lanzhou 730030, P. R. China;
2. Department of Tumor Surgery, Lanzhou University Second Hospital, Lanzhou 730030, P. R. China;
3. Key Laboratory of Digestive System Tumors, Lanzhou University Second Hospital, Lanzhou 730030, P. R. China;

Corresponding?author：

CHEN Hao, Email: ery_chenh@lzu.edu.cn

Keywords：

gastric cancer; lymph node dissection; lymphatic tracer; radical gastrectomy

DOI：

10.7507/1007-9424.202105049

Video：

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Objective To investigate the research progress of assisted techniques for lymph node dissection in gastric cancer. Method The literatures on the applications of assisted techniques of lymph node dissection in the gastric cancer radical gastrectomy in recent years were reviewed. Results At present, the assisted techniques used for lymph node dissection in the radical gastrectomy mainly included the lymphatic tracing technology and laparoscopic and robotic surgeries. The lymphatic tracing technology mainly included the use of dye tracers, indocyanine green, gamma probe, intraoperative radiation technology, etc. Among which gamma probe and intraoperative radiation technology were expensive and not suitable for clinical application, and intraoperative radiation technology had a radiation risk, so it was rarely used currently. At present, the dye tracers and indocyanine green were mainly used in the clinical lymph node tracing, both of which could improve the detection rate and increase the number of lymph node dissection, and improve the prognosis of patients. The laparoscopic radical gastrectomy was not inferior to traditional radical gastrectomy in terms of lymph node dissection, and had been more widely used in the clinical practice due to its advantages of visualization, minimally invasive, quickly postoperative recovery, and good short-term efficacy. Compared with the conventional laparoscopic system, the robotic surgical system was more precise, dexterous, stable, and had a better feedback feeling, which was more conducive to the lymph node dissection of special location. Conclusion Use of lymphatic tracers, laparoscopy and robotics could increase lymph node detection rate and improve prognosis of patients.

Citation： DING Tianlong, XU Bo, WANG Yunpeng, ZHANG Jing, WANG Haiyun, HE Puyi, ZHU Jingyu, CHEN Hao. Research progress of assisted techniques for lymph node dissection in gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(4): 534-538. doi: 10.7507/1007-9424.202105049 Copy

1.	Cui N, Sun Q, Liu H, et al. Long non-coding RNA LINC00511 regulates the expression of microRNA-625-5p and activates signal transducers and activators of transcription 3 (STAT3) to accelerate the progression of gastric cancer. Bioengineered, 2021, 12(1): 2915-2927.
2.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
3.	Sura K, Ye H, Vu CC, et al. How many lymph nodes are enough-defining the extent of lymph node dissection in stage Ⅰ–Ⅲ gastric cancer using the National Cancer Database. J Gastrointest Oncol, 2018, 9(6): 1168-1175.
4.	No authors listed. IARC monographs on the evaluation of carcinogenic risks to humans. Solar and ultraviolet radiation. IARC Monogr Eval Carcinog Risks Hum, 1992, 55: 1-316.
5.	Guo F, Mao X, Wang J, et al. Gemcitabine adsorbed onto carbon particles increases drug concentrations at the injection site and in the regional lymph nodes in an animal experiment and a clinical study. J Int Med Res, 2011, 39(6): 2217-2227.
6.	Li Z, Ao S, Bu Z, et al. Clinical study of harvesting lymph nodes with carbon nanoparticles in advanced gastric cancer: a prospective randomized trial. World J Surg Oncol, 2016, 14: 88. doi: 10.1186/s12957-016-0835-3.
7.	Wu X, Lin Q, Chen G, et al. Sentinel lymph node detection using carbon nanoparticles in patients with early breast cancer. PLoS One, 2015, 10(8): e0135714. doi: 10.1371/journal.pone.0135714.
8.	Xu XF, Gu J. The application of carbon nanoparticles in the lymph node biopsy of cN0 papillary thyroid carcinoma: a randomized controlled clinical trial. Asian J Surg, 2017, 40(5): 345-349.
9.	麥麥提·艾合麥提, 劉少壯, 陳成, 等. 術前胃鏡下納米碳標記在腹腔鏡胃癌根治術中的應用價值. 腹腔鏡外科雜志, 2018, 23(1): 31-35.
10.	Landsman ML, Kwant G, Mook GA, et al. Light-absorbing properties, stability, and spectral stabilization of indocyanine green. J Appl Physiol, 1976, 40(4): 575-583.
11.	Alander JT, Kaartinen I, Laakso A, et al. A review of indocyanine green fluorescent imaging in surgery. Int J Biomed Imaging, 2012, 2012: 940585. doi: 10.1155/2012/940585.
12.	Schaafsma BE, Mieog JS, Hutteman M, et al. The clinical use of indocyanine green as a near-infrared fluorescent contrast agent for image-guided oncologic surgery. J Surg Oncol, 2011, 104(3): 323-332.
13.	Schols RM, Bouvy ND, van Dam RM, et al. Advanced intraoperative imaging methods for laparoscopic anatomy navigation: an overview. Surg Endosc, 2013, 27(6): 1851-1859.
14.	Guo J, Yang H, Wang S, et al. Comparison of sentinel lymph node biopsy guided by indocyanine green, blue dye, and their combination in breast cancer patients: a prospective cohort study. World J Surg Oncol, 2017, 15(1): 196. doi: 10.1186/s12957-017-1264-7.
15.	Gilmore DM, Khullar OV, Jaklitsch MT, et al. Identification of metastatic nodal disease in a phase 1 dose-escalation trial of intraoperative sentinel lymph node mapping in non-small cell lung cancer using near-infrared imaging. J Thorac Cardiovasc Surg, 2013, 146(3): 562-570.
16.	Valente SA, Al-Hilli Z, Radford DM, et al. Near infrared fluorescent lymph node mapping with indocyanine green in breast cancer patients: a prospective trial. J Am Coll Surg, 2019, 228(4): 672-678.
17.	Yamashita S, Tokuishi K, Anami K, et al. Video-assisted thoracoscopic indocyanine green fluorescence imaging system shows sentinel lymph nodes in non-small-cell lung cancer. J Thorac Cardiovasc Surg, 2011, 141(1): 141-144.
18.	郭文斌, 高偉, 劉金濤, 等. 吲哚菁綠熒光導航技術在乳腺癌前哨淋巴結活檢中的應用. 中國普通外科雜志, 2015, 24(5): 658-662.
19.	陳涵, 葉玉坤, 韓開寶, 等. 吲哚菁綠近紅外光成像系統在非小細胞肺癌術中探尋前哨淋巴結的臨床應用研究. 中華臨床醫師雜志(電子版), 2013, 7(23): 10599-10603.
20.	Kim TH, Kong SH, Park JH, et al. Assessment of the completeness of lymph node dissection using near-infrared imaging with indocyanine green in laparoscopic gastrectomy for gastric cancer. J Gastric Cancer, 2018, 18(2): 161-171.
21.	涂儒鴻, 林建賢, 鄭朝輝, 等. 吲哚菁綠熒光成像在腹腔鏡胃癌根治術淋巴結清掃中的應用價值. 中華消化外科雜志, 2019, 18(5): 466-471.
22.	Yano K, Nimura H, Mitsumori N, et al. The efficiency of micrometastasis by sentinel node navigation surgery using indocyanine green and infrared ray laparoscopy system for gastric cancer. Gastric Cancer, 2012, 15(3): 287-291.
23.	Chen QY, Xie JW, Zhong Q, et al. Safety and efficacy of indocyanine green tracer-guided lymph node dissection during laparoscopic radical gastrectomy in patients with gastric cancer: a randomized clinical trial. JAMA Surg, 2020, 155(4): 300-311.
24.	Kwon IG, Son T, Kim HI, et al. Fluorescent lymphography-guided lymphadenectomy during robotic radical gastrectomy for gastric cancer. JAMA Surg, 2019, 154(2): 150-158.
25.	中國研究型醫院學會微創外科學專業委員會《腹腔鏡外科雜志》編輯部. 吲哚菁綠標記熒光腹腔鏡技術在腹腔鏡胃癌根治術中的應用專家共識. 腹腔鏡外科雜志, 2019, 24(5): 395-400.
26.	Huh YJ, Lee HJ, Kim TH, et al. Efficacy of assessing intraoperative bowel perfusion with near-Infrared camera in laparoscopic gastric cancer surgery. J Laparoendosc Adv Surg Tech A, 2019, 29(4): 476-483.
27.	Kusano M, Tajima Y, Yamazaki K, et al. Sentinel node mapping guided by indocyanine green fluorescence imaging: a new method for sentinel node navigation surgery in gastrointestinal cancer. Dig Surg, 2008, 25(2): 103-108.
28.	Tajima Y, Yamazaki K, Masuda Y, et al. Sentinel node mapping guided by indocyanine green fluorescence imaging in gastric cancer. Ann Surg, 2009, 249(1): 58-62.
29.	Kitagawa Y, Takeuchi H, Takagi Y, et al. Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol, 2013, 31(29): 3704-3710.
30.	中華醫學會外科學分會胃腸外科學組. 吲哚菁綠近紅外光成像在腹腔鏡胃癌根治術中應用中國專家共識(2019版). 中國實用外科雜志, 2020, 40(2): 139-144.
31.	Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth Ⅰ gastrectomy. Surg Laparosc Endosc, 1994, 4(2): 146-148.
32.	郭欣, 邊識博, 彭正, 等. 進展期胃癌根治術中脾門淋巴結清掃的手術方式選擇及轉移預警評價: 一項前瞻性單中心隨機對照研究. 中華胃腸外科雜志, 2020, 23(2): 144-145.
33.	周宏, 夏加增, 陳義鋼. 胃癌腹腔鏡輔助手術與開腹手術的單中心回顧性對照研究. 實用醫學雜志, 2018, 34(19): 3255-3259.
34.	Aiolfi A, Lombardo F, Matsushima K, et al. Systematic review and updated network meta-analysis of randomized controlled trials comparing open, laparoscopic-assisted, and robotic distal gastrectomy for early and locally advanced gastric cancer. Surgery, 2021, 170(3): 942-951.
35.	Lee HJ, Hyung WJ, Yang HK, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg, 2019, 270(6): 983-991.
36.	張珂誠, 曹博, 衛勃, 等. 機器人與腹腔鏡輔助胃癌根治術中復雜部位淋巴結清掃對比研究. 中國腫瘤臨床, 2019, 46(11): 546-550.
37.	Kim YW, Reim D, Park JY, et al. Role of robot-assisted distal gastrectomy compared to laparoscopy-assisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer. Surg Endosc, 2016, 30(4): 1547-1552.
38.	Huang YQ, Liang CH, He L, et al. Development and validation of a radiomics nomogram for preoperative prediction of lymph node metastasis in colorectal cancer. J Clin Oncol, 2016, 34(18): 2157-2164.
39.	Nie K, Shi L, Chen Q, et al. Rectal cancer: assessment of neoadjuvant chemoradiation outcome based on radiomics of multiparametric MRI. Clin Cancer Res, 2016, 22(21): 5256-5264.
40.	Jiang Y, Chen C, Xie J, et al. Radiomics signature of computed tomography imaging for prediction of survival and chemotherapeutic benefits in gastric cancer. EBioMedicine, 2018, 36: 171-182.

1. Cui N, Sun Q, Liu H, et al. Long non-coding RNA LINC00511 regulates the expression of microRNA-625-5p and activates signal transducers and activators of transcription 3 (STAT3) to accelerate the progression of gastric cancer. Bioengineered, 2021, 12(1): 2915-2927.
2. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
3. Sura K, Ye H, Vu CC, et al. How many lymph nodes are enough-defining the extent of lymph node dissection in stage Ⅰ–Ⅲ gastric cancer using the National Cancer Database. J Gastrointest Oncol, 2018, 9(6): 1168-1175.
4. No authors listed. IARC monographs on the evaluation of carcinogenic risks to humans. Solar and ultraviolet radiation. IARC Monogr Eval Carcinog Risks Hum, 1992, 55: 1-316.
5. Guo F, Mao X, Wang J, et al. Gemcitabine adsorbed onto carbon particles increases drug concentrations at the injection site and in the regional lymph nodes in an animal experiment and a clinical study. J Int Med Res, 2011, 39(6): 2217-2227.
6. Li Z, Ao S, Bu Z, et al. Clinical study of harvesting lymph nodes with carbon nanoparticles in advanced gastric cancer: a prospective randomized trial. World J Surg Oncol, 2016, 14: 88. doi: 10.1186/s12957-016-0835-3.
7. Wu X, Lin Q, Chen G, et al. Sentinel lymph node detection using carbon nanoparticles in patients with early breast cancer. PLoS One, 2015, 10(8): e0135714. doi: 10.1371/journal.pone.0135714.
8. Xu XF, Gu J. The application of carbon nanoparticles in the lymph node biopsy of cN0 papillary thyroid carcinoma: a randomized controlled clinical trial. Asian J Surg, 2017, 40(5): 345-349.
9. 麥麥提·艾合麥提, 劉少壯, 陳成, 等. 術前胃鏡下納米碳標記在腹腔鏡胃癌根治術中的應用價值. 腹腔鏡外科雜志, 2018, 23(1): 31-35.
10. Landsman ML, Kwant G, Mook GA, et al. Light-absorbing properties, stability, and spectral stabilization of indocyanine green. J Appl Physiol, 1976, 40(4): 575-583.
11. Alander JT, Kaartinen I, Laakso A, et al. A review of indocyanine green fluorescent imaging in surgery. Int J Biomed Imaging, 2012, 2012: 940585. doi: 10.1155/2012/940585.
12. Schaafsma BE, Mieog JS, Hutteman M, et al. The clinical use of indocyanine green as a near-infrared fluorescent contrast agent for image-guided oncologic surgery. J Surg Oncol, 2011, 104(3): 323-332.
13. Schols RM, Bouvy ND, van Dam RM, et al. Advanced intraoperative imaging methods for laparoscopic anatomy navigation: an overview. Surg Endosc, 2013, 27(6): 1851-1859.
14. Guo J, Yang H, Wang S, et al. Comparison of sentinel lymph node biopsy guided by indocyanine green, blue dye, and their combination in breast cancer patients: a prospective cohort study. World J Surg Oncol, 2017, 15(1): 196. doi: 10.1186/s12957-017-1264-7.
15. Gilmore DM, Khullar OV, Jaklitsch MT, et al. Identification of metastatic nodal disease in a phase 1 dose-escalation trial of intraoperative sentinel lymph node mapping in non-small cell lung cancer using near-infrared imaging. J Thorac Cardiovasc Surg, 2013, 146(3): 562-570.
16. Valente SA, Al-Hilli Z, Radford DM, et al. Near infrared fluorescent lymph node mapping with indocyanine green in breast cancer patients: a prospective trial. J Am Coll Surg, 2019, 228(4): 672-678.
17. Yamashita S, Tokuishi K, Anami K, et al. Video-assisted thoracoscopic indocyanine green fluorescence imaging system shows sentinel lymph nodes in non-small-cell lung cancer. J Thorac Cardiovasc Surg, 2011, 141(1): 141-144.
18. 郭文斌, 高偉, 劉金濤, 等. 吲哚菁綠熒光導航技術在乳腺癌前哨淋巴結活檢中的應用. 中國普通外科雜志, 2015, 24(5): 658-662.
19. 陳涵, 葉玉坤, 韓開寶, 等. 吲哚菁綠近紅外光成像系統在非小細胞肺癌術中探尋前哨淋巴結的臨床應用研究. 中華臨床醫師雜志(電子版), 2013, 7(23): 10599-10603.
20. Kim TH, Kong SH, Park JH, et al. Assessment of the completeness of lymph node dissection using near-infrared imaging with indocyanine green in laparoscopic gastrectomy for gastric cancer. J Gastric Cancer, 2018, 18(2): 161-171.
21. 涂儒鴻, 林建賢, 鄭朝輝, 等. 吲哚菁綠熒光成像在腹腔鏡胃癌根治術淋巴結清掃中的應用價值. 中華消化外科雜志, 2019, 18(5): 466-471.
22. Yano K, Nimura H, Mitsumori N, et al. The efficiency of micrometastasis by sentinel node navigation surgery using indocyanine green and infrared ray laparoscopy system for gastric cancer. Gastric Cancer, 2012, 15(3): 287-291.
23. Chen QY, Xie JW, Zhong Q, et al. Safety and efficacy of indocyanine green tracer-guided lymph node dissection during laparoscopic radical gastrectomy in patients with gastric cancer: a randomized clinical trial. JAMA Surg, 2020, 155(4): 300-311.
24. Kwon IG, Son T, Kim HI, et al. Fluorescent lymphography-guided lymphadenectomy during robotic radical gastrectomy for gastric cancer. JAMA Surg, 2019, 154(2): 150-158.
25. 中國研究型醫院學會微創外科學專業委員會《腹腔鏡外科雜志》編輯部. 吲哚菁綠標記熒光腹腔鏡技術在腹腔鏡胃癌根治術中的應用專家共識. 腹腔鏡外科雜志, 2019, 24(5): 395-400.
26. Huh YJ, Lee HJ, Kim TH, et al. Efficacy of assessing intraoperative bowel perfusion with near-Infrared camera in laparoscopic gastric cancer surgery. J Laparoendosc Adv Surg Tech A, 2019, 29(4): 476-483.
27. Kusano M, Tajima Y, Yamazaki K, et al. Sentinel node mapping guided by indocyanine green fluorescence imaging: a new method for sentinel node navigation surgery in gastrointestinal cancer. Dig Surg, 2008, 25(2): 103-108.
28. Tajima Y, Yamazaki K, Masuda Y, et al. Sentinel node mapping guided by indocyanine green fluorescence imaging in gastric cancer. Ann Surg, 2009, 249(1): 58-62.
29. Kitagawa Y, Takeuchi H, Takagi Y, et al. Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol, 2013, 31(29): 3704-3710.
30. 中華醫學會外科學分會胃腸外科學組. 吲哚菁綠近紅外光成像在腹腔鏡胃癌根治術中應用中國專家共識(2019版). 中國實用外科雜志, 2020, 40(2): 139-144.
31. Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth Ⅰ gastrectomy. Surg Laparosc Endosc, 1994, 4(2): 146-148.
32. 郭欣, 邊識博, 彭正, 等. 進展期胃癌根治術中脾門淋巴結清掃的手術方式選擇及轉移預警評價: 一項前瞻性單中心隨機對照研究. 中華胃腸外科雜志, 2020, 23(2): 144-145.
33. 周宏, 夏加增, 陳義鋼. 胃癌腹腔鏡輔助手術與開腹手術的單中心回顧性對照研究. 實用醫學雜志, 2018, 34(19): 3255-3259.
34. Aiolfi A, Lombardo F, Matsushima K, et al. Systematic review and updated network meta-analysis of randomized controlled trials comparing open, laparoscopic-assisted, and robotic distal gastrectomy for early and locally advanced gastric cancer. Surgery, 2021, 170(3): 942-951.
35. Lee HJ, Hyung WJ, Yang HK, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg, 2019, 270(6): 983-991.
36. 張珂誠, 曹博, 衛勃, 等. 機器人與腹腔鏡輔助胃癌根治術中復雜部位淋巴結清掃對比研究. 中國腫瘤臨床, 2019, 46(11): 546-550.
37. Kim YW, Reim D, Park JY, et al. Role of robot-assisted distal gastrectomy compared to laparoscopy-assisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer. Surg Endosc, 2016, 30(4): 1547-1552.
38. Huang YQ, Liang CH, He L, et al. Development and validation of a radiomics nomogram for preoperative prediction of lymph node metastasis in colorectal cancer. J Clin Oncol, 2016, 34(18): 2157-2164.
39. Nie K, Shi L, Chen Q, et al. Rectal cancer: assessment of neoadjuvant chemoradiation outcome based on radiomics of multiparametric MRI. Clin Cancer Res, 2016, 22(21): 5256-5264.
40. Jiang Y, Chen C, Xie J, et al. Radiomics signature of computed tomography imaging for prediction of survival and chemotherapeutic benefits in gastric cancer. EBioMedicine, 2018, 36: 171-182.

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