gms | German Medical Science

128. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

03.05. - 06.05.2011, München

Combination of ex vivo sentinel lymph node mapping and methylene blue assisted lymph node dissection in gastric cancer: a prospective and randomized study

Meeting Abstract

  • Johann Bernhard Spatz - Zentralklinikum Augsburg, Abteilung für Allgemein-, Viszeral- und Transplantationschirurgie, Augsburg
  • Hans M. Arnholdt - Zentralklinikum Augsburg, Institut für Pathologie, Augsburg
  • Matthias Anthuber - Klinikum Augsburg, Allgemein-, Viszeral-, Transplantationschirurgie, Augsburg
  • Bruno Märkl - Zentralklinikum Augsburg, Institut für Pathologie, Augsburg

Deutsche Gesellschaft für Chirurgie. 128. Kongress der Deutschen Gesellschaft für Chirurgie. München, 03.-06.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgch633

DOI: 10.3205/11dgch633, URN: urn:nbn:de:0183-11dgch6330

Published: May 20, 2011

© 2011 Spatz et al.
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Outline

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Introduction: Exact lymph node staging is crucial to estimate prognosis of gastric cancer and stratify treatment. Recently, a new concept for improving lymph node harvest and the accuracy of lymph node staging was introduced. It combines methylene blue assisted lymph node dissection (MBLND) with a new ex vivo sentinel lymph node (evSLN) mapping technique. Aim of this study was to investigate these techniques in a prospective and randomized manner.

Materials and methods: 50 patients with proved or suspected gastric cancer were enrolled. Patients were randomized to either conventional technique (Unstained, n=25) or MBLND (Methylene, n=25). In 46 cases additional evSLN mapping was performed using black ink as marker dye.

Results: MBLND significantly improved lymph node harvest (36 ± 10 vs. 21 ± 10; P < 0.001) in comparison to conventional technique. The biggest differences were seen in LNs ≤ 6 mm. Sufficient lymph node harvest was achieved in 96% of the Methylene group compared to 56% of the Unstained group (P = 0.002). In contrast to conventional technique adequate lymph node harvest was archieved irrespective of partial gastrectomy or preoperative chemotherapy in the Methylene group. The SLN detection rate, sensitivity and accuracy were 87%, 81% and 93%, respectively. The probability to show metastatic involvement was twice as high in the SLN than in the rest of the lymph nodes. Isolated tumor cells were detected after immunohistochemical staining in 3 of 17 cases 18%.

Conclusion: MBLND significantly improves lymph node harvest in gastric cancer . Moreover, evSLN mapping is feasible and holds the potential to increase detection of metastatic nodules.