[Lymphatic basin dissection and function-preserving limited gastrectomy for early-stage gastric carcinoma]

Sentinel node biopsy accurately predicts the nodal status of early-stage gastric carcinomas. Nevertheless, surgeons are concerned about missing a micrometastasis in applying the sentinel node-negative finding to surgery. Of 36 patients who underwent D2 dissection based on positive sentinel node biopsy, 15 patients had histologic metastasis in the sentinel nodes, 20 patients in both the sentinel and nonsentinel nodes in the lymphatic basin system, and 1 in the nodes not only in the basins but also in the nonbasin system. This means that metastases spread along the anatomic lymphatic flows in the early stage. Micrometastases of the sentinel nodes develop prior to histologic appearance, and the neighboring nonsentinel nodes are also possibly involved in the early stage. This suggests that, even in the case of cancer-free sentinel nodes, the basins should be dissected. Since 1995, we have performed lymphatic basin dissections and limited gastric resections on 159 sentinel node-negative patients. The crude survival curve was not different from that of the conventional group. The incidence of postoperative distress such as early satiety, unsatisfactory recovery of body weight dumping syndrome, duodenogastric reflux, and gallstone formation was significantly lower in the limited group than that in the conventional group.