Endoscopic submucosal dissection with sentinel node navigation surgery for early gastric cancer

We combined endoscopic submucosal dissection (ESD) and sentinel node navigation surgery with the purpose of achieving complete resection of early gastric cancer while preserving the organ and assessing pathological nodal status. A total of 13 patients with cT1( ≤ 3 cm)N0 early gastric cancer underwent combined ESD and sentinel node navigation surgery (ESN) at a single tertiary referral center. Sentinel node navigation surgery using indocyanine green was performed during ESD and all suspected sentinel nodes were removed laparoscopically and examined intraoperatively. ESN was converted to gastrectomy with D2 dissection if there was evidence of metastasis on frozen section. ESN was completed in 12 patients and in 1 patient was converted to gastrectomy after sentinel node navigation surgery. En bloc tumor resection was achieved in all cases. Two patients underwent additional gastrectomy because they had tumor-positive vertical margins. In all cases ESN was conducted without intraoperative or postoperative adverse events. ESN is a feasible minimally invasive procedure that allows en bloc tumor resection to be achieved while assessing the pathological status of the lymph nodes.

• References

• 1 Gotoda T, Yanagisawa A, Sasako M et al. Incidence of lymph node metastasis from early gastric cancer: estimation with large number of cases at two large centers. Gastric Cancer 2000; 3: 219-225
• 2 Yasuda K, Shiraishi N, Suematsu T et al. Rate of detection of lymph node metastasis is correlated with the depth of submucosal invasion in early stage gastric carcinoma. Cancer 1999; 85: 2119-2123
• 3 Polkowski M, Palucki J, Wronska E et al. EUS versus helical tomography for locoregional staging of gastric cancer. Endoscopy 2004; 36: 617-623
• 4 Masaki K, Yuko K. Universal applications of sentinel node technology. Ann Surg Oncol 2004; 11 (03) 144s-146s
• 5 Kitagawa Y, Takeuchi H, Takagi Y et al. Prospective multicenter trial of sentinel node mapping for gastric cancer. J Clin Oncol ASCO Annual Meeting Abstracts 2009; 27 (15) 4518
• 6 Nakajima T. Gastric Cancer treatment guidelines in Japan. Gastric Cancer 2002; 5: 1-5
• 7 Kwee RM, Kwee TH. Predicting lymph node status in early gastric cancer. Review. Gastric Cancer 2008; 11: 134-148
• 8 Kim JH, Song KS, Youn YH et al. Clinicopathologic factors influence accurate endosonographic assessment for early gastric cancer. Gastrointest Endosc 2007; 66: 901-908
• 9 Kitagawa Y, Saikawa Y, Takeuchi H et al. Sentinel node navigation in early stage gastric cancer: updated data and current status. Scand J Surg 2006; 95: 256-259
• 10 Saikawa Y, Otani Y, Kitagawa Y et al. Interim results of sentinel node biopsy during laparoscopic gastrectomy: possible role in function-preserving surgery for early cancer. World J Surg 2006; 30: 1962-1968
• 11 Ichikura T, Sugawawa H, Sakamoto N et al. Limited gastrectomy with dissection of sentinel node stations for early gastric cancer with negative sentinel node biopsy. Ann Surg 2009; 249: 942-947
• 12 Lee SE, Lee JH, Ryu KW et al. Sentinel node mapping and skip metastases in patients with early gastric cancer. Ann Surg Oncol 2009; 16: 603-608
• 13 Ryu KW, Eom BW, Nam BH et al. Is the sentinel node biopsy clinically applicable for limited lymphadenectomy and modified gastric resection in gastric cancer? A meta-analysis of feasibility studies.. J Surg Oncol 2011; 104: 578-584
• 14 Cho WY, Kim YJ, Cho JY et al. Hybrid natural orifice transluminal endoscopic surgery: endoscopic full-thickness resection of early gastric cancer and laparoscopic regional lymph node dissection – 14 human cases. Endoscopy 2011; 43: 134-139
• 15 Nimura H, Narimiya N, Mitsumori N et al. Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer. Br J Surg 2004; 91: 575-579
• 16 Miyashiro I, Miyoshi N, Hiratsuka M et al. Detection of sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging: comparison with infrared imaging. Ann Surg Oncol 2008; 15: 1640-1643