Regional Lymph Node Dissection as an Additional Treatment Option to Endoscopic Resection for Expanded Indications in...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Endoscopic Procedures

Background:

• Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) has expanded indications, raising concerns about undertreatment without adequate lymph node dissection (LND).
• Regional lymph node dissection (RLND) is a minimally invasive technique for limited lymphadenectomy, potentially avoiding radical gastrectomy.

Purpose of the Study:

• To evaluate the safety and effectiveness of RLND as an adjunct to ESD for EGC meeting expanded criteria.
• To establish RLND as a viable treatment option for selected EGC patients undergoing ESD.

Main Methods:

• Prospective enrollment of 69 patients with EGC meeting expanded ESD indications (2014-2017).
• Tumor localization via intraoperative esophagogastroduodenoscopy (EGD) prior to RLND.
• All patients underwent RLND followed by radical gastrectomy with LND; comparison of preoperative and intraoperative EGD findings; analysis of primary lesion pathology and RLND status.

Main Results:

• Concordance rates for tumor location between preoperative and intraoperative EGD were 79.7% (longitudinal), 76.8% (circumferential), and 63.8% (regional).
• Four patients (5.7%) had metastatic lymph nodes (LNs); three exceeded ESD expanded indications, and one had a single regional LN metastasis.

Conclusions:

• Regional lymph node dissection (RLND) is a safe and effective additional treatment for early gastric cancer (EGC) patients undergoing endoscopic submucosal dissection (ESD) within expanded indications.
• RLND offers a potentially less invasive approach for lymph node management in specific EGC cases.