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Endoscopic submucosal dissection with sentinel node navigation surgery for early gastric cancer
1Gastrointestinal Cancer Center, Soonchunhyang University Hospital, Seoul, Korea.
Endoscopy
|September 19, 2012
Summary
Endoscopic submucosal dissection (ESD) combined with sentinel node navigation surgery (ESN) offers a feasible, minimally invasive approach for early gastric cancer. This technique achieves complete tumor resection while assessing lymph node status, preserving the organ.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Early gastric cancer (EGC) management requires balancing complete tumor resection with organ preservation.
- Accurate pathological nodal status assessment is crucial for staging and treatment planning in EGC.
Purpose of the Study:
- To evaluate the feasibility and outcomes of combining endoscopic submucosal dissection (ESD) with sentinel node navigation surgery (SNNS) for EGC.
- To assess the efficacy of this combined approach in achieving en bloc tumor resection and pathological nodal status evaluation.
- To determine the safety and potential for organ preservation using this minimally invasive technique.
Main Methods:
- A prospective study involving 13 patients with clinical T1 (≤3 cm) N0 EGC.
- Combined endoscopic submucosal dissection (ESD) and sentinel node navigation surgery (SNNS) using indocyanine green.
- Intraoperative laparoscopic removal and frozen section analysis of suspected sentinel nodes.
- Conversion to gastrectomy with D2 dissection if nodal metastasis was confirmed.
Main Results:
- The combined endoscopic submucosal dissection and sentinel node navigation surgery (ESN) procedure was successfully completed in 12 out of 13 patients.
- One patient required conversion to gastrectomy following sentinel node navigation surgery due to metastasis.
- En bloc tumor resection was achieved in all cases.
- Two patients underwent additional gastrectomy for positive vertical margins.
- No intraoperative or postoperative adverse events were reported.
Conclusions:
- Combined endoscopic submucosal dissection and sentinel node navigation surgery (ESN) is a feasible and safe minimally invasive option for selected early gastric cancer patients.
- This approach enables en bloc tumor resection and accurate pathological assessment of lymph node status.
- ESN holds potential for organ preservation in early gastric cancer management.
