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Li P, Li Z, Linghu E, Ji J. Chinese national clinical practice guidelines on the prevention, diagnosis, and treatment of early gastric cancer. Chin Med J (Engl) 2024; 137:887-908. [PMID: 38515297 PMCID: PMC11046028 DOI: 10.1097/cm9.0000000000003101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Gastric cancer is one of the most common malignant tumors in the digestive system in China. Few comprehensive practice guidelines for early gastric cancer in China are currently available. Therefore, we created the Chinese national clinical practice guideline for the prevention, diagnosis, and treatment of early gastric cancer. METHODS This clinical practice guideline (CPG) was developed in accordance with the World Health Organization's recommended process and with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) in assessing evidence quality. We used the Evidence to Decision framework to formulate clinical recommendations to minimize bias and increase transparency in the CPG development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and the Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guidelines to ensure completeness and transparency of the CPG. RESULTS This CPG contains 40 recommendations regarding the prevention, screening, diagnosis, treatment, and follow-up of early gastric cancer based on available clinical studies and guidelines. We provide recommendations for the timing of Helicobacter pylori eradication, screening populations for early gastric cancer, indications for endoscopic resection and surgical gastrectomy, follow-up interval after treatment, and other recommendations. CONCLUSIONS This CPG can lead to optimum care for patients and populations by providing up-to-date medical information. We intend this CPG for widespread adoption to increase the standard of prevention, screening, diagnosis, treatment, and follow-up of early gastric cancer; thereby, contributing to improving national health care and patient quality of life.
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Affiliation(s)
- Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050, China
| | - Ziyu Li
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, the First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
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2
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Zhou J, Li R, Zhao S, Sun L, Wang J, Fu Y, Wang D. Sentinel Node Navigation Surgery for Early Gastric Cancer: A Narrative Review. Am J Clin Oncol 2024:00000421-990000000-00183. [PMID: 38587337 DOI: 10.1097/coc.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Early gastric cancer (EGC) refers to malignant tumor lesions that are limited to the mucosa and submucosa layers, regardless of the presence of lymph node metastasis. Typically, EGC has a low rate of perigastric lymph node metastasis, and long-term survival outcomes are good after radical surgical treatment. The primary objective of surgical treatment for EGC is to achieve functional preservation while ensuring a radical cure. Sentinel node navigation surgery (SNNS) is a surgical technique used in the treatment of EGC. This approach achieves functional preservation by limiting lymph node dissection and performing restrictive gastrectomy guided by intraoperative negative sentinel node (SN) biopsy. Despite the apparent improvement in the detection rate of SN with the emergence of various tracing dyes and laparoscopic fluorescence systems, the oncological safety of SNNS remains a controversial research topic. SNNS, as a true form of stomach preservation surgery that enhances the quality of life, has become a topic of interest in the EGC field. In recent years, scholars from Japan and South Korea have conducted extensive research on the feasibility and safety of SNNS in the treatment of EGC. This article aims to provide reference choices for surgeons treating EGC by reviewing relevant research on SNNS for EGC in recent years.
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Affiliation(s)
- Jiajie Zhou
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Ruiqi Li
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Shuai Zhao
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Longhe Sun
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jie Wang
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Yayan Fu
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Daorong Wang
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
- Northern Jiangsu People's Hospital, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Disease, Yangzhou, China
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3
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Yanagimoto Y, Kurokawa Y, Doki Y. Essential updates 2021/2022: Perioperative and surgical treatments for gastric and esophagogastric junction cancer. Ann Gastroenterol Surg 2023; 7:698-708. [PMID: 37663969 PMCID: PMC10472390 DOI: 10.1002/ags3.12711] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 09/05/2023] Open
Abstract
In recent years, important clinical trials for gastric cancer (GC) and esophagogastric junction cancer (EGJC) have been reported, changing the strategies of surgical and perioperative treatment. Although laparoscopic gastrectomy has already been shown to be effective for early-stage cancer, recent evidence from both Asia (JLSSG0901, CLASS-01 and KLASS-02) and Europe (LOGICA and STOMACH trials) has demonstrated that it is useful for advanced GC. Robotic surgery has been rapidly gaining popularity in recent years, and randomized controlled trials are ongoing to evaluate its efficacy. A prospective nationwide multicenter study mapped sites with frequent metastasis and revealed lymphatic flow specific to EGJC, thus establishing the optimal lymph node dissection area and surgical approach based on esophageal involvement. Perioperative chemotherapy, the mainstay of treatment in Europe, also has been established in Asia by the PRODIGY and RESOLVE studies. New clinical trials have been conducted to evaluate the efficacy of combining immunotherapy or molecular-targeted therapy with perioperative chemotherapy or chemoradiotherapy. In this review, we present important recent clinical trials regarding the treatment of GC and EGJC published in 2021 or 2022.
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Affiliation(s)
| | - Yukinori Kurokawa
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
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Vasconcelos AC, Dinis-Ribeiro M, Libânio D. Endoscopic Resection of Early Gastric Cancer and Pre-Malignant Gastric Lesions. Cancers (Basel) 2023; 15:3084. [PMID: 37370695 DOI: 10.3390/cancers15123084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Early gastric cancer comprises gastric malignancies that are confined to the mucosa or submucosa, irrespective of lymph node metastasis. Endoscopic resection is currently pivotal for the management of such early lesions, and it is the recommended treatment for tumors presenting a very low risk of lymph node metastasis. In general, these lesions consist of two groups of differentiated mucosal adenocarcinomas: non-ulcerated lesions (regardless of their size) and small ulcerated lesions. Endoscopic submucosal dissection is the technique of choice in most cases. This procedure has high rates of complete histological resection while maintaining gastric anatomy and its functions, resulting in fewer adverse events than surgery and having a lesser impact on patient-reported quality of life. Nonetheless, approximately 20% of resected lesions do not fulfill curative criteria and demand further treatment, highlighting the importance of patient selection. Additionally, the preservation of the stomach results in a moderate risk of metachronous lesions, which underlines the need for surveillance. We review the current evidence regarding the endoscopic treatment of early gastric cancer, including the short-and long-term results and management after resection.
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Affiliation(s)
- Ana Clara Vasconcelos
- Department of Gastroenterology, Porto Comprehensive Cancer Center Raquel Seruca, and RISE@CI-IPO (Health Research Network), 4200-072 Porto, Portugal
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Porto Comprehensive Cancer Center Raquel Seruca, and RISE@CI-IPO (Health Research Network), 4200-072 Porto, Portugal
- MEDCIDS (Department of Community Medicine, Health Information, and Decision), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Diogo Libânio
- Department of Gastroenterology, Porto Comprehensive Cancer Center Raquel Seruca, and RISE@CI-IPO (Health Research Network), 4200-072 Porto, Portugal
- MEDCIDS (Department of Community Medicine, Health Information, and Decision), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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5
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Liao Y, Zhao J, Chen Y, Zhao B, Fang Y, Wang F, Wei C, Ma Y, Ji H, Wang D, Tang D. Mapping Lymph Node during Indocyanine Green Fluorescence-Imaging Guided Gastric Oncologic Surgery: Current Applications and Future Directions. Cancers (Basel) 2022; 14:cancers14205143. [PMID: 36291927 PMCID: PMC9601265 DOI: 10.3390/cancers14205143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Huge strides have been made in the navigation of gastric cancer surgery thanks to the improvement of intraoperative techniques. For now, the use of indocyanine green (ICG) enhanced fluorescence imaging has received promising results in detecting sentinel lymph nodes (SLNs) and tracing lymphatic drainages, which make it applicable for limited and precise lymphadenectomy. Nevertheless, issues of the lack of specificity and unpredictable false-negative lymph nodes were encountered in gastric oncologic surgery practice using ICG-enhanced fluorescence imaging (ICG-FI), which restrict its application. Here, we reviewed the current application of ICG-FI and assessed potential approaches to improving ICG-FI.
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Affiliation(s)
- Yiqun Liao
- Department of Clinical Medical College, The Yangzhou School of Clinical Medicine, Dalian Medical University, Dalian 116044, China
| | - Jiahao Zhao
- Department of Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Yuji Chen
- Department of Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Bin Zhao
- Department of Clinical Medical College, The Yangzhou School of Clinical Medicine, Dalian Medical University, Dalian 116044, China
| | - Yongkun Fang
- Department of Clinical Medical College, The Yangzhou School of Clinical Medicine, Dalian Medical University, Dalian 116044, China
| | - Fei Wang
- Department of Clinical Medical College, The Yangzhou School of Clinical Medicine, Dalian Medical University, Dalian 116044, China
| | - Chen Wei
- Department of Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Yichao Ma
- Department of Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Hao Ji
- Department of Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Daorong Wang
- Department of General Surgery, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
| | - Dong Tang
- Department of General Surgery, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
- Correspondence: ; Tel.: +86-189527835
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Kim YW, Min JS, Yoon HM, An JY, Eom BW, Hur H, Lee YJ, Cho GS, Park YK, Jung MR, Park JH, Hyung WJ, Jeong SH, Kook MC, Han M, Nam BH, Ryu KW. Laparoscopic Sentinel Node Navigation Surgery for Stomach Preservation in Patients With Early Gastric Cancer: A Randomized Clinical Trial. J Clin Oncol 2022; 40:2342-2351. [PMID: 35324317 PMCID: PMC9287280 DOI: 10.1200/jco.21.02242] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To compare postoperative complications, long-term survival, and quality of life (QOL) after laparoscopic sentinel node navigation surgery (LSNNS) and laparoscopic standard gastrectomy (LSG). METHODS Five hundred eighty patients with preoperatively diagnosed stage IA gastric adenocarcinoma (≤ 3 cm) were assigned to undergo either LSG or LSNNS. Observers were not blinded to patient grouping. The primary outcome was 3-year disease-free survival (3y-DFS). Secondary outcomes included postoperative complications, QOL, 3-year disease-specific survival (3y-DSS), and 3-year overall survival (3y-OS). RESULTS In total, 527 patients were included in the modified intention-to-treat analysis population for the primary outcome (LSG, 269; LSNNS, 258). Stomach-preserving surgery was performed in 210 patients (81%) in the LSNNS group. During the median follow-up duration, the 3y-DFS rates in the LSG and LSNNS groups were 95.5% and 91.8%, respectively (difference: 3.7%; 95% CI, -0.6 to 8.1). Three patients with recurrence and five with metachronous gastric cancer in the LSNNS group underwent standard surgery. Two patients with distant metastasis in both groups were treated with palliative chemotherapy. The 3y-DSS and 3y-OS rates in the LSG and LSNNS groups were 99.5% and 99.1% (P = .59) and 99.2% and 97.6% (P = .17), respectively. Postoperative complications occurred in 19.0% of the LSG group and 15.5% of the LSNNS group (P = .294). The LSNNS group showed better physical function (P = .015), less symptoms (P < .001), and improved nutrition than the LSG group. CONCLUSION LSNNS did not show noninferiority to LSG for 3y-DFS, with a 5% margin. However, the 3y-DSS and 3y-OS were not different after rescue surgery in cases of recurrence/metachronous gastric cancer, and LSNNS had better long-term QOL and nutrition than LSG.
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Affiliation(s)
- Young-Woo Kim
- Center of Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Korea
| | - Hong Man Yoon
- Center of Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Ji Yeong An
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Current Affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bang Wool Eom
- Center of Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Young Joon Lee
- Department of Surgery, Gyeongsang National University, Jinju, Korea
| | - Gyu Seok Cho
- Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Young-Kyu Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University, Jinju, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University, Jinju, Korea
| | | | - Mira Han
- Biostatistics Collaboration Team, National Cancer Center, Goyang, Korea
| | - Byung-Ho Nam
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.,Current Affiliation: Clinical Design Research Center, HERINGS The Institution of Advanced Clinical & Biomedical Research, Seoul, Korea
| | - Keun Won Ryu
- Center of Gastric Cancer, National Cancer Center, Goyang, Korea
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Lee S, Kim H. Minimally invasive surgery in advanced gastric cancer. Ann Gastroenterol Surg 2022; 6:336-343. [PMID: 35634188 PMCID: PMC9130905 DOI: 10.1002/ags3.12559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 11/12/2022] Open
Abstract
Since Dr. Kitano introduced laparoscopic distal gastrectomy for early gastric cancer in 1994, there have been remarkable advances in minimally invasive surgery (MIS) for gastric cancer, including robotic surgery. With the efforts of many clinical researchers and consenting patients, medical knowledge and evidence for laparoscopic surgery in gastric cancer have accumulated. Although many gastric surgeons are comfortable with the clinical application of laparoscopic surgery for early gastric cancer, the adoption of MISs for advanced gastric cancer remains controversial. In this review article, we describe the current status and evidence of MIS from an evidence‐based medicine viewpoint and explore the feasibility and effectiveness of MIS for advanced gastric cancer in the real world.
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Affiliation(s)
- Sangjun Lee
- Department of Surgery Seoul National University Bundang Hospital Seongnam Korea
| | - Hyung‐Ho Kim
- Department of Surgery Seoul National University Bundang Hospital Seongnam Korea
- Department of Surgery Seoul National University College of Medicine Seoul Korea
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Hiramatsu Y, Kikuchi H, Takeuchi H. Function-Preserving Gastrectomy for Early Gastric Cancer. Cancers (Basel) 2021; 13:cancers13246223. [PMID: 34944841 PMCID: PMC8699305 DOI: 10.3390/cancers13246223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/05/2021] [Accepted: 12/09/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary For patients with early gastric cancer (EGC), a good prognosis is achieved by conventional standard gastrectomy with radical lymphadenectomy. However, postgastrectomy syndrome is often inevitable and results in decreased quality of life (QOL). To improve patients’ QOL, proximal gastrectomy instead of total gastrectomy and pylorus-preserving gastrectomy instead of distal gastrectomy have been widely accepted as function-preserving gastrectomies. Recently, personalized, minimized gastrectomy with sentinel node navigation surgery has been developed and is expected to be an ideal treatment option for patients with EGC. Herein, we review the indications, surgical techniques, and postoperative outcomes of function-preserving gastrectomy. Abstract Recently, minimally invasive (endoscopic or laparoscopic) treatment for early gastric cancer (EGC) has been widely accepted. However, a standard gastrectomy with radical lymphadenectomy is generally performed in patients with EGC who have no indications for endoscopic resection, and postgastrectomy dysfunction is one of the problems of standard gastrectomy. Function-preserving gastrectomy, such as proximal gastrectomy and pylorus-preserving gastrectomy, can be considered when attempting to preserve the patient’s quality of life (QOL) postoperatively. In addition, sentinel node navigation surgery for EGC has been applied in clinical practice in several prospective studies on function-preserving personalized minimized gastrectomy. In the near future, the sentinel lymph node concept is expected to form the basis for establishing an ideal, personalized, minimally invasive function-preserving treatment for patients with EGC, which will improve their postoperative QOL without compromising their long-term survival. In this review article, we summarize the current status, surgical techniques, and postoperative outcomes of function-preserving gastrectomy for EGC.
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Affiliation(s)
- Yoshihiro Hiramatsu
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan; (Y.H.); (H.K.)
- Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan; (Y.H.); (H.K.)
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan; (Y.H.); (H.K.)
- Correspondence: ; Tel.: +81-53-435-2279
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Park SH, Kim JM, Park SS. Current Status and Trends of Minimally Invasive Gastrectomy in Korea. Medicina (B Aires) 2021; 57:medicina57111195. [PMID: 34833413 PMCID: PMC8621245 DOI: 10.3390/medicina57111195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
Since its introduction in the early 1990s, laparoscopic gastrectomy has been widely accepted for the treatment of gastric cancer worldwide. In the last decade, the Korean Laparoendoscopic Gastrointestinal Surgery Study group performed important clinical trials and exerted various efforts to enhance the quality of scientific knowledge and surgical techniques in the field of gastric cancer surgery. Laparoscopic gastrectomy has shifted to a new era in Korea due to recent advances and innovations in technology. Here, we discuss the recent updates of laparoscopic gastrectomy—namely, reduced-port, single-incision, robotic, image-guided, and oncometabolic surgery.
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Affiliation(s)
- Shin-Hoo Park
- Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea;
- Division of Foregut Surgery, Department of Surgery, Korea University Anam Hospital, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea
| | - Jong-Min Kim
- Department of Surgery, Min General Surgery Hospital, 155 Dobong-ro, Gangbuk-gu, Seoul 01171, Korea;
| | - Sung-Soo Park
- Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea;
- Division of Foregut Surgery, Department of Surgery, Korea University Anam Hospital, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea
- Correspondence: or ; Tel.: +82-2-920-6772; Fax: +82-2-928-1631
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Kim HY, Chang W, Lee YJ, Park JH, Cho J, Na HY, Ahn H, Hwang SI, Lee HJ, Kim YH, Lee KH. Adrenal Nodules Detected at Staging CT in Patients with Resectable Gastric Cancers Have a Low Incidence of Malignancy. Radiology 2021; 302:129-137. [PMID: 34665031 DOI: 10.1148/radiol.2021211210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Guidelines recommending additional imaging for adrenal nodules lack relevant epidemiologic evidence. Purpose To measure the prevalence of adrenal nodules detected at staging CT in patients with potentially resectable gastric cancer and the proportion of patients with malignant nodules among them. Materials and Methods This retrospective study included 10 250 consecutive patients (median age, 63 years; interquartile range, 53-71 years; 6884 men) who underwent staging CT and had potentially resectable gastric cancer in a tertiary center (May 2003 to December 2018). All 10 250 CT studies were retrospectively reviewed, and patients with adrenal nodules (or thickening ≥10 mm) were identified to measure the prevalence of adrenal nodules. Among patients with adrenal nodules, the per-patient proportions of malignant nodules, adrenal metastasis from gastric cancer, and additional adrenal examinations were measured. A secondary analysis was performed by using data from the original CT reports. The same metrics that were used in the retrospective review were assessed. Results The prevalence of adrenal nodules was 4.5% (95% CI: 4.1, 4.9; 462 of 10 250). The proportions of malignant nodules and adrenal metastasis from gastric cancer were 0.4% ( 95% CI: 0.1, 1.6; two of 462) and 0% (95% CI: 0.0, 0.8; 0 of 462), respectively. A total of 27% of the patients (95% CI: 23, 31; 123 of 462) underwent additional adrenal examination. According to original CT reports, the prevalence of adrenal nodules and the proportions of malignant nodules, adrenal metastases from gastric cancer, and additional adrenal examination were 2.7% (95% CI: 2.4, 3.0; 272 of 10 250), 0.7% (95% CI: 0.1, 2.6; two of 272), 0% (95% CI: 0.0, 1.4; 0 of 272), and 42.6% (95% CI: 36.7, 48.8; 116 of 272), respectively. Conclusion Although adrenal nodules were detected frequently on staging CT images of patients with otherwise resectable gastric cancer, these nodules were rarely malignant. ©RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Baumgarten in this issue.
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Affiliation(s)
- Hae Young Kim
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Won Chang
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Yoon Jin Lee
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Ji Hoon Park
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Jungheum Cho
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Hee Young Na
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Hyungwoo Ahn
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Sung Il Hwang
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Hak Jong Lee
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Young Hoon Kim
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
| | - Kyoung Ho Lee
- From the Departments of Radiology (H.Y.K., W.C., Y.J.L., J.H.P., J.C., H.A., S.I.H., H.J.L., Y.H.K., K.H.L.) and Pathology (H.Y.N.), Seoul National University Bundang Hospital, 82 Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (H.Y.N.); Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (K.H.L.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (H.J.L., Y.H.K., K.H.L.); and Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea (K.H.L.)
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11
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Youn SI, Son SY, Lee K, Won Y, Min S, Park YS, Ahn SH, Kim HH. Quality of life after laparoscopic sentinel node navigation surgery in early gastric cancer: a single-center cohort study. Gastric Cancer 2021; 24:744-751. [PMID: 33389274 DOI: 10.1007/s10120-020-01145-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the quality of life (QOL) of patients after laparoscopic sentinel node navigation surgery (SNNS) compared to conventional laparoscopy-assisted distal gastrectomy (LADG) in early gastric cancer patients. METHODS Patients recruited for laparoscopic SNNS surgery between July 2010 and April 2013 were assessed for their QOL. A historical control group was established, consisting of patients who underwent conventional LADG with radical lymphadenectomy from the same institution. QOL questionnaire was taken serially from preoperative week 1 until 12 months postoperatively (1, 3, 6, and 12 months) using the Korean version of the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire-core (QLQ-C30) and gastric cancer-specific questionnaire (STO22). RESULTS A total of 80 prospectively gathered patients who received SNNS were categorized into the comparison group (SNNS group). The QOL was compared with 78 patients identified to have received LADG from the gastric cancer database of our institution and were sorted into the control group (LADG group). In QLQ-C30, SNNS group showed better functioning scales in all except role functioning and better scores from the symptom scales in fatigue, insomnia, and diarrhea compared to the LADG group. In QLQ-STO22, scores on dysphagia, eating restriction, anxiety, and body image disturbance were better in SNNS group. CONCLUSIONS Postoperative QOL in laparoscopic gastrectomy combined with SNNS is superior compared to conventional laparoscopic distal gastrectomy in patients with stage I gastric cancer.
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Affiliation(s)
- Sang Il Youn
- Department of Surgery, Seoul National University Bundang Hospital, Gumi-ro 173-82, Bundang-gu, Seongnam, Gyenggi-do, 463-707, Republic of Korea
| | - Sang Yong Son
- Department of Surgery, Ajou University Hospital, Suwon-Si, Korea
| | - Kanghaeng Lee
- Department of Surgery, Seoul National University Bundang Hospital, Gumi-ro 173-82, Bundang-gu, Seongnam, Gyenggi-do, 463-707, Republic of Korea
| | - Yongjoon Won
- Department of Surgery, Seoul National University Bundang Hospital, Gumi-ro 173-82, Bundang-gu, Seongnam, Gyenggi-do, 463-707, Republic of Korea
| | - Sahong Min
- Department of Surgery, Seoul National University Bundang Hospital, Gumi-ro 173-82, Bundang-gu, Seongnam, Gyenggi-do, 463-707, Republic of Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Gumi-ro 173-82, Bundang-gu, Seongnam, Gyenggi-do, 463-707, Republic of Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Gumi-ro 173-82, Bundang-gu, Seongnam, Gyenggi-do, 463-707, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Gumi-ro 173-82, Bundang-gu, Seongnam, Gyenggi-do, 463-707, Republic of Korea.
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12
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Huang Y, Pan M, Deng Z, Ji Y, Chen B. How useful is sentinel lymph node biopsy for the status of lymph node metastasis in cT1N0M0 gastric cancer? A systematic review and meta-analysis. Updates Surg 2021; 73:1275-1284. [PMID: 33723712 DOI: 10.1007/s13304-021-01026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
Sentinel lymph node biopsy (SLNB) is intriguing because it is expected to further expand the indication of endoscopic resection (ER) for cT1N0M0 gastric cancer and as an additional operation for post-ER gastric cancer. The aim of our study was to perform a systematic review and meta-analysis on the feasibility and diagnostic value of SLNB technique in patients with cT1N0M0 gastric cancer. Eligible studies were systematically searched in PubMed, Embase, and Cochrane Library databases from inception to April 2020. A random-effect model was used to pool the data, and subgroup analysis was used to explain the heterogeneities. A total of 22 clinical studies (1993 patients with cT1N0M0 gastric cancer) were included. The pooled SLN identification rate, sensitivity, specificity, and diagnostic odds ratio with 95% confidence intervals were 0.99 (0.99-1.00), 0.92 (0.88-0.95), 1.00 (1.00-1.00), and 832.8 (395.5-1753.6), respectively. The summary receiver operator characteristic displayed a test accuracy of 99.3%. Subgroup analysis found an improved SLN sensitivity for studies with the mean number of SLNs > 4 and studies stained with a combination of hematoxylin-eosin with immunohistochemistry (HE + IHC). Further, studies using the basin dissection were associated with a higher SLN identification rate. The current meta-analysis provides data that favors the use of SLNB for predicting the status of lymph node metastasis in patients with cT1N0M0 gastric cancer. However, establishing standard procedure and suitable criteria for further application and optimization of SLNB is urgently needed.
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Affiliation(s)
- Yuqiang Huang
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, China.,Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Mengting Pan
- Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Zhiwei Deng
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, China
| | - Yufei Ji
- Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Bo Chen
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, China. .,Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China. .,Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361001, China.
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13
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Huang Y, Pan M, Chen B. A Systematic Review and Meta-Analysis of Sentinel Lymph Node Biopsy in Gastric Cancer, an Optimization of Imaging Protocol for Tracer Mapping. World J Surg 2021; 45:1126-1134. [PMID: 33389000 DOI: 10.1007/s00268-020-05900-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) plays an essential role in the evaluation of lymph node (LN) metastasis status and the extent of LN dissection in gastric cancer. The aim of our study was to perform a systematic review and meta-analysis for corresponding identification rate and sensitivity of different SLNB techniques. METHODS Systematic search using PubMed, Embase, and Cochrane library databases was conducted for studies on SLNB in patients with gastric cancer. Studies were stratified according to the sentinel lymph node (SLN) biopsy technique: blue dye (BD), radiocolloid tracer (RI), indocyanine green (ICG), a combination of radiocolloid with blue dye (RI + BD), and a combination of radiocolloid with ICG (RI + ICG). A random-effect model was used to pool the identification rate, sensitivity, and accuracy. RESULTS A total of 54 eligible studies (3767 patients) was included. The pooled identification rates of SLNB using BD, RI, ICG, RI + BD, RI + ICG were 95% (95%CI: 92-97%), 95% (95%CI: 93-97%), 99% (95%CI: 97-99%), 97% (95%CI: 96-98%), and 95% (95%CI: 87-99%), respectively. The pooled sensitivities were 82% (95%CI: 77-86%), 87% (95%CI: 81-92%), 90% (95%CI: 82-95%), 89% (95%CI: 84-93%), and 88% (95%CI: 79-94%), respectively. The pooled accuracies were 94% (95%CI: 91-96%), 95% (95%CI: 92-97%), 98% (95%CI: 95-99%), 97% (95%CI: 95-99%), and 98% (95%CI: 95-99%), respectively. CONCLUSIONS The current meta-analysis provides reliable evidence that favors the use of ICG and dual tracer method (RI + BD/ICG) for the identification of the SLN. Considering the high costs and potential biohazard of using radioactive substances in dual tracer method, performing SLNB with ICG is the technique of choice for experienced surgeons.
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Affiliation(s)
- Yuqiang Huang
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, China.,Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China
| | - Mengting Pan
- Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China
| | - Bo Chen
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, China. .,Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China.
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14
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Kim SG, Eom BW, Yoon HM, Kim CG, Kook MC, Kim YW, Ryu KW. Recent updates and current issues of sentinel node navigation surgery for early gastric cancer. Chin J Cancer Res 2021; 33:142-149. [PMID: 34158734 PMCID: PMC8181869 DOI: 10.21147/j.issn.1000-9604.2021.02.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
With the increase in the incidence of early gastric cancer (EGC), several endoscopic and laparoscopic approaches, such as endoscopic submucosal dissection and function-preserving gastrectomy, have been accepted as standard treatments. Sentinel node navigation surgery (SNNS) is an ideal surgical option for preservation of most parts of the stomach and consequent maintenance of normal gastric function to improve quality of life in patients with EGC. Although many previous studies and clinical trials have demonstrated the safety and feasibility of the sentinel node concept in gastric cancer, the clinical application of SNNS is debatable. Several issues regarding technical standardization and oncological safety need to be resolved. Recently several studies to resolve these problems are being actively performed, and SNNS might be an important surgical option in the treatment of gastric cancer in the future.
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Affiliation(s)
- Sung Gon Kim
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Myeong-Cherl Kook
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
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15
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An JY, Min JS, Hur H, Lee YJ, Cho GS, Park YK, Jung MR, Park JH, Hyung WJ, Jeong SH, Kim YW, Yoon HM, Eom BW, Kook MC, Han MR, Nam BH, Ryu KW. Laparoscopic sentinel node navigation surgery versus laparoscopic gastrectomy with lymph node dissection for early gastric cancer: short-term outcomes of a multicentre randomized controlled trial (SENORITA). Br J Surg 2020; 107:1429-1439. [PMID: 32492186 DOI: 10.1002/bjs.11655] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/05/2020] [Accepted: 04/06/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sentinel node navigation surgery reduces the extent of gastric and lymph node dissection, and may improve quality of life. The benefit and harm of laparoscopic sentinel node navigation surgery (LSNNS) for early gastric cancer is unknown. The SENORITA (SEntinel Node ORIented Tailored Approach) trial investigated the pathological and surgical outcomes of LSNNS compared with laparoscopic standard gastrectomy (LSG) with lymph node dissection. METHODS The SENORITA trial was an investigator-initiated, open-label, parallel-assigned, non-inferiority, multicentre RCT conducted in Korea. The primary endpoint was 3-year disease-free survival. The secondary endpoints, morbidity and mortality within 30 days of surgery, are reported in the present study. RESULTS A total of 580 patients were randomized to LSG (292) or LSNNS (288). Surgery was undertaken in 527 patients (LSG 269, LSNNS 258). LSNNS could be performed according to the protocol in 245 of 258 patients, and a sentinel node basin was detected in 237 (96·7 per cent) Stomach-preserving surgery was carried out in 210 of 258 patients (81·4 per cent). Postoperative complications occurred in 51 patients in the LSG group (19·0 per cent) and 40 (15·5 per cent) in the LSNNS group (P = 0·294). Complications with a Clavien-Dindo grade of III or higher occurred in 16 (5·9 per cent) and 13 (5·0 per cent) patients in the LSG and LSNNS groups respectively (P = 0·647). CONCLUSION The rate and severity of complications following LSNNS for early gastric cancer are comparable to those after LSG with lymph node dissection. Registration number: NCT01804998 ( http://www.clinicaltrials.gov).
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Affiliation(s)
- J Y An
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.,Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J-S Min
- Departments of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Centre, Busan, South Korea
| | - H Hur
- Ajou University School of Medicine, Suwon, South Korea
| | - Y J Lee
- Gyeongsang National University, Jinju, South Korea
| | - G S Cho
- Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Y-K Park
- Chonnam National University Medical School, Gwangju, South Korea
| | - M R Jung
- Chonnam National University Medical School, Gwangju, South Korea
| | - J-H Park
- Gyeongsang National University, Jinju, South Korea
| | - W J Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - S-H Jeong
- Gyeongsang National University, Jinju, South Korea
| | - Y-W Kim
- Centre for Gastric Cancer.,Department of Cancer Control and Population Health, National Cancer Centre Graduate School of Cancer Science and Policy, Goyang, South Korea
| | | | | | | | - M R Han
- Biostatistics Collaboration Team, National Cancer Centre, Goyang, South Korea
| | - B-H Nam
- Clinical Design Research Centre, HERINGS Institute of Advanced Clinical and Biomedical Research, Seoul, South Korea
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16
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Sentinel lymph node detection for gastric cancer: Promise or pitfall? Surg Oncol 2019; 33:1-6. [PMID: 31885358 DOI: 10.1016/j.suronc.2019.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/24/2019] [Accepted: 12/18/2019] [Indexed: 12/15/2022]
Abstract
At present, optimal surgery for gastric cancer is still under debate, especially the extent of lymph node dissection. Gastrectomy with D1/D2 lymphadenectomy is standard treatment for resectable advanced gastric cancer. However, in early gastric cancer without lymph node metastasis, gastrectomy with D1/D2 lymphadenectomy may not be unnecessary, which could increases morbidity and mortality and reduces the quality of life (QOL). Therefore, the concept of sentinel lymph node could be applied in gastric cancer. But due to the complexity of gastric lymphatic drainage, there are still many issues under debate, such as suitable tracers, the method of mapping and collecting and the oncologic safety of sentinel node navigation surgery (SNNS). In addition, skip metastasis and unreliability of intraoperative pathological diagnosis are two main reasons for false negative cases. In this review, we summarize the current status and controversy of sentinel lymph node detection in gastric cancer, attempting to help with practical application. Further, we hold opinion that we should be cautious about performing sentinel lymph node detection in gastric cancer before an accurate and effective method occurs.
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17
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Safety and location analysis of transumbilical endoscopic submucosal dissection with single-basin lymph node dissection in the upper gastric body: a porcine model. Surg Endosc 2019; 34:590-597. [PMID: 31016457 PMCID: PMC6957557 DOI: 10.1007/s00464-019-06801-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/17/2019] [Indexed: 12/16/2022]
Abstract
Background In our previous study, transumbilical endoscopic submucosal dissection (TU-ESD) was revealed to be feasible, but delayed gastric perforation was observed in 30% of ESD sites. In this study, we aimed to verify locations at which it is feasible to perform TU-ESD in the upper gastric body and to demonstrate the safety of TU-ESD in single-basin lymph node dissection (SBLND). Methods In vitro, TU-ESD was performed at three lesion sites (anterior wall, AW; posterior wall, PW; and lesser curvature, LC) in each porcine stomach using an EASIE-R tray (cases = 10). In vivo, TU-ESD was performed with SBLND in 9 pigs. Seven days after the operation, the pigs were sacrificed and examined. Results In the in vitro feasibility study, the TU-ESD time was significantly faster in the PW group (5.9 ± 2.0 min) than in the LC group (8.5 ± 1.5 min) (p < 0.05) in all 10 cases. In the in vivo survival study, TU-ESD with SBLND was successfully performed without any complications (N = 9). There were no cases of delayed perforation, and healing ulcers were found in all pigs 7 days after the operation. Ulcer size (5.2 ± 3.5 cm2) was approximately 36% smaller than that observed at the ESD operation site (8.1 ± 1.9 cm2) (p = 0.05). Epithelialization in the margin and healing of the gastric ulcers were confirmed by microscopy. Conclusions TU-ESD with SBLND is a feasible and safe method. The upper posterior gastric body could be the most feasible location for performing TU-ESD, perhaps because of the difference in the subcutaneous dissection time.
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