Abstract
Endoscopic resection (ER) is the treatment of choice for early gastric cancer (T1) without lymph node involvement. An additional gastrectomy with D2 lymphadenectomy is recommended if ER is considered as non-curative. Here, we present a case of a robot-assisted sentinel lymph node procedure performed with the use of duel-tracer, including ICG fluorescence and technetium-99, after a non-curative ESD for an early gastric tumor. Five “hot” lymph nodes were resected, one of which was positive for metastasis. A subtotal gastrectomy with D2 lymphadenectomy was performed additionally during the same procedure. This case presentation indicates the feasibility of a robot-assisted sentinel lymph node procedure in early gastric cancer.
Highlights
Gastric cancer is defined as a T1N0 stage tumor, with tumor invasion limited to the mucosa or submucosa [1]
An additional gastrectomy with D2 lymphadenectomy is recommended if endoscopic resection (ER) is considered as non-curative at the pathological evaluation, in order to remove possible lymph node metastasis or local residual tumor [1,2,3,4]
A recent meta-analysis concluded that sentinel node mapping with the use of indocyanine green (ICG) fluorescence imaging in gastric cancer is feasible with encouraging results in terms of detection rate, accuracy and sensitivity [9]
Summary
Gastric cancer is defined as a T1N0 stage tumor, with tumor invasion limited to the mucosa or submucosa [1]. In line with the Japanese gastric cancer guideline, the European Society of Gastrointestinal Endoscopy (ESGE) guideline recommends endoscopic resection (ER), including endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), as treatment of choice for early gastric cancer without lymph node involvement [3]. An additional gastrectomy with D2 lymphadenectomy is recommended if ER is considered as non-curative at the pathological evaluation, in order to remove possible lymph node metastasis or local residual tumor [1,2,3,4]. Studies have indicated lymph node metastasis to be present in only 5-10% of patients who underwent an additional gastrectomy after a non-curative ER [5,6,7,8]. We present the case of a Western patient who underwent ESD treatment for a high risk early gastric tumor.
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