Abstract
Sentinel node navigation surgery (SNNS) has been recognized as a minimally invasive tool for individualized lymphadenectomy in patients with early gastric cancer (EGC). The aim of this study was to compare clinicopathological factors, adverse events, and clinical outcomes between sentinel node mapping (SNM) and SN dissection (SND) groups and assess the clinical utility of SNNS in patients with EGC. The clinical data of 157 patients with EGC, diagnosed as clinical T1N0M0 with tumors ≤ 40 mm, undergoing SNNS between March 2004 and April 2016 were retrospectively reviewed. Twenty-seven patients were excluded from the analysis. In the remaining 130 patients, 59 and 71 patients underwent standard lymphadenectomy for SNM and SND, respectively. The sentinel node detection rate in the SNM and SND groups was 98.3% (58/59) and 100% (71/71), respectively. Two (3.5%), 15 (25.9%), and 41 (70.7%) patients having sentinel nodes underwent total gastrectomy, proximal gastrectomy (PG), and distal gastrectomy (DG), respectively, in the SNM group. One (1.4%), 5 (7.0%), 10 (14.1%), 39 (54.9%), and 16 (22.5%) patients underwent PG, DG, segmental gastrectomy, local resection, and endoscopic submucosal dissection, respectively, in the SND group. There was no significant difference in postoperative complications between the SNM and SND groups (P = 0.781). Survival did not differ between the both groups (P = 0.856). The present results suggest that personalized surgery with SND provides technical safety and curability related with a favorable survival outcome in patients with EGC.
Highlights
Gastric cancer is one of the most common malignancies in Asia [1]
We focused on lymph node micrometastasis and reported that Sentinel node navigation surgery (SNNS) is a promising surgical tool for patients with cT1N0 gastric cancer, even when lymph node micrometastasis is detectable by molecular approaches, such as immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR) [5, 6]
The majority of patients with cT1a, cT1b1, and tumors ≤ 20 mm was selected as the sentinel node (SN) dissection (SND) group
Summary
The prevalence of early gastric cancer (EGC) among patients with gastric cancer ranges from 50% to 60% in Japan [2, 3]. These findings indicate that the percentage of patients with EGC has increased. According to a prospective multicenter trial in Japan, the sentinel node (SN) detection rate and the accuracy of SNNS for metastatic status in 397 patients with clinical T1 (cT1) or T2 (cT2) and cN0 gastric cancer measuring < 4 cm were 97.5% and 99%, www.impactjournals.com/oncotarget respectively [8]. Patients enrolled in these studies underwent curative gastrectomy with standard lymphadenectomy for SN mapping (SNM), and patients treated with individualized gastrectomy based on the SN concept were excluded from these studies [4,5,6,7,8,9]
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