Sentinel Node Concept in Gastric Carcinoma

To assess the applicability of thesentinel node concept to gastric carcinoma. The location of metastaticlymph nodes was analyzed retrospectively in 119 patients with gastriccarcinoma in whom metastasis was limited to one or two nodes.Intraoperative lymphatic mapping was attempted in 62 patients usingindocyanine green injected endoscopically into the gastric submucosaadjacent to the tumor. Metastatic lymph nodes were distributed beyondthe perigastric area in 4% of patients with a single node involved.The positive node was located along the greater curvature in 21% ofthe patients with a tumor on the lesser curvature. Two patients had ametastatic node totally occupied by cancer tissue. In 16% of patientswith two nodes involved, a positive node was located on both the lesserand greater curvatures. Lymphatic mapping was successful in allsubjects. A larger number and wider distribution of green-stained nodeswere observed in patients injected with 8 ml of indocyanine greensolution than in those injected with 4 ml. No metastasis was observedin any nodes in 47 (96%) of the 49 patients who had no metastasis ingreen nodes. In one patient showing metastasis in non-green nodeswithout metastasis in green nodes, the positive nodes were totallyoccupied by cancer tissue. Our results showed the complexity oflymphatic streams within and from the stomach. Lymphatic mapping usingindocyanine green can be a tool for identifying sentinel nodes ingastric carcinoma although lymph nodes occupied by cancer tissue maynot be detected by this technique.