Abstract
BackgroundStandard gastrectomy with systematic lymphadenectomy as an additional surgery after endoscopic resection (ER) causes a deterioration in long-term quality of life. If the sentinel lymph node (SN) basin concept can be applied in post-ER gastric cancer, minimal surgery can be applied without reducing the curability. This retrospective multicenter cohort study aimed to verify the validity of the SN basin concept in post-ER gastric cancer.Patients and methodsIndividual data of 132 patients who underwent SN mapping after ER were collected from 8 university hospitals in Japan from 2001 to 2016. Tracers were injected endoscopically in the submucosal layer at four sites around the post-ER scar. We compared the SN basin distribution of post-ER gastric cancer with that of 275 patients with non-ER gastric cancer.ResultsTwo cases of SN were unidentified, both involving a single tracer (SN detection rate: 98.5%). Nine cases (6.8%) of lymph node metastasis were found, of which eight had a metastatic lymph node within the SNs and one had a non-SN metastasis within the SN basin. The diagnostic sensitivity of SN mapping for lymph node metastasis was 88.9% in post-ER group and 95.7% in non-ER group (P = 0.490); the accuracy was 99.2% and 99.6% (P = 0.539), respectively. Regarding the SN basin, no significant intergroup differences were found regardless of the primary tumor location.ConclusionsOur findings clarified the feasibility of SN mapping based on the SN basin concept in patients with gastric cancer who previously underwent ER.
Highlights
IntroductionIn 2017, 45.6% of patients with newly diagnosed gastric cancer were > 75 years old [1]
The population of patients with gastric cancer is currently aging in Japan
The primary tumor in both cases with an unidentified sentinel lymph node (SN) was a T1b-SM2 lesion that had been subjected to endoscopic submucosal dissection (ESD)
Summary
In 2017, 45.6% of patients with newly diagnosed gastric cancer were > 75 years old [1] In such a patient background, the popularity of endoscopic resection (ER), including endoscopic mucosal resection (EMR) [2] and endoscopic submucosal dissection (ESD) [3, 4], as a less invasive treatment modality for early gastric cancer has spread dramatically. According to the Japanese guidelines for gastric cancer treatment [5], lesions with < 1% estimated risk of lymph node metastasis are considered equivalent to surgical gastrectomy and defined as absolute-indication lesions. If the sentinel lymph node (SN) basin concept can be applied in post-ER gastric cancer, minimal surgery can be applied without reducing the curability.
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