Function-preserving gastrectomy based on the sentinel node concept in early gastric cancer

Area of Science:

• Surgical Oncology
• Gastroenterology
• Medical Imaging

Background:

• Sentinel node (SN) mapping is increasingly recognized for its role in staging early gastric cancer.
• Accurate lymph node status determination is crucial for tailoring surgical interventions and improving patient outcomes.
• Current methods like dual-tracer techniques and emerging technologies like indocyanine green imaging are vital for SN detection.

Purpose of the Study:

• To evaluate the efficacy and safety of function-preserving gastrectomy combined with SN mapping in early gastric cancer patients.
• To assess the impact of this surgical approach on long-term survival and patient quality of life.
• To explore the potential of novel techniques such as Non-exposed endoscopic wall-inversion surgery (NEWS) in conjunction with SN biopsy.

Main Methods:

• A multicenter prospective trial was conducted in Japan.
• Sentinel node mapping was performed using established dual-tracer methods and advanced imaging technologies.
• Function-preserving gastrectomy techniques, including partial, proximal, segmental, and pylorus-preserving gastrectomies, were evaluated.
• The novel Non-exposed endoscopic wall-inversion surgery (NEWS) technique was investigated in combination with SN biopsy.

Main Results:

• Sentinel node mapping demonstrated acceptable detection rates and accuracy in determining lymph node metastasis.
• Function-preserving gastrectomy, guided by SN status, is theoretically feasible and was evaluated for its impact on survival and quality of life.
• The combination of NEWS and SN biopsy shows potential as a minimally invasive, function-preserving surgical option for cN0 early gastric cancer.

Conclusions:

• Sentinel node mapping is a key technology for personalized surgical management in early gastric cancer.
• Function-preserving gastrectomy, when SNs are non-metastatic, offers a viable approach to improve patient quality of life.
• The integration of NEWS with SN biopsy presents a promising, minimally invasive surgical strategy for early gastric cancer, particularly in cN0 cases.