Gastric lymphatic flows may change before and after endoscopic submucosal dissection: in vivo porcine survival models

Kyoko Nohara, Osamu Goto, Hiroya Takeuchi, Motoki Sasaki, Tadateru Maehata, Naohisa Yahagi, Yuko Kitagawa

研究成果: Article査読

7 被引用数 (Scopus)

抄録

Background and study aim: Standard gastrectomy with lymphadenectomy is recommended following endoscopic submucosal dissection (ESD) due to the risk of lymph-node metastasis for resected cancers. However, when lymphatic flows remain unchanged after ESD, a minimally invasive function-preserving surgery based on the sentinel node (SN) concept may be applicable. In this study, using porcine survival models, we aimed to investigate whether gastric lymphatic flows were modified following ESD. Methods: Twelve pigs, each with one simulating lesion 3 cm in size, were used. Indocyanine green (ICG) fluid was endoscopically injected into the submucosa in four quadrants surrounding the lesion. Following laparoscopic observation of lymphatic flows, the lesions were resected by ESD. After 4 weeks, ICG fluid was injected in four quadrants surrounding the scar and lymphatic flows were observed in the same manner as the initial procedure. The distribution of lymphatic flows, including stained SNs, was compared. Results: In ten lesions (83.3%), the distribution of flows remained unchanged. However, in one lesion, the flow along the right gastric epiploic artery (R-GEA) disappeared on the lesser curvature of the middle stomach. In addition, in one lesion, the flow along R-GEA emerged on the lesser curvature of the lower stomach. Conclusions: Our study revealed that, despite ESD, lymphatic flows remained unchanged in most parts of the stomach. The SN concept may be applied after ESD, except for lesions on the lesser curvature. However, in the case of the lesser curvature, special care must be given to the SN concept.

本文言語English
ページ(範囲)723-730
ページ数8
ジャーナルGastric Cancer
22
4
DOI
出版ステータスPublished - 2019 7 12

ASJC Scopus subject areas

  • 腫瘍学
  • 消化器病学
  • 癌研究

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