BACKGROUND: The well-instituted and planned surgery is the unique effective treatment for gastric cancer. However, in the last four decades, we haven´t seen significant improvements in the cure results, specially in the Ocident. The ink injection is realized for the best identification of lymph node groups. The principal benefit of endoscopic gastric submucosal ink injections is for the lymphadenectomies, where it can facilitate the accurate lymph node localization. Moreover, sentinel lymph node researches can be done using the lymphadenochromatography, with the purpose of racional and selective application of lymphadenectomy, principally in the more difficult lymph node group resections, minimizing complications. The perigastric lymphadenochromatography with activated carbon (CH40) has been studied in this clinical study (phase 2). AIM: 1) To determine the percentage of lymph node stained after endoscopic injection of CH40 in the peritumoral gastric submucosa; 2) to determine the percentage of perigastric lymph node with metastasis stained by CH40; 3) to evaluate the lymph node staining with CH40 as a metastatic marker. METHODS: Ten patients, with different gastric cancer stages, were prospectively studied. Diagnosis of gastric cancer was performed by upper digestive endoscopy with biopsies and pathological analysis. Preoperative injection of CH40 in the peritumoral gastric submucosa was performed. All patients were operated and the lymph node groups, from the different perigastric lymph node chains, were dissected and resected. They were separated according to the Japanese Gastric Cancer Association (JGCA) concepts. RESULTS: The age varied from 50 to 68, average of 58,9. Six were male and four female patients. 481 lymph nodes were ressected, with the average of 48,1 for each surgery. There were 368 stained lymph nodes (76,5%) and 113 (23,5%) without staining. Perigastric lymph nodes with metastasis were stained by CH40 in 75% (51 from 68). However, 25% (17 from 68) of metastatic lymph nodes had no ink. CONCLUSIONS: The lymphadenochromatograhy with CH40 was not an efficient metastatic marker in this study. In this phase 2 clinical study there was no stratification of stages.
Carbon; Stomach neoplasms; Chromatography; Lymph hodes
