Sealed endoscopic full-thickness resection with sentinel node navigation for early gastric cancer without endoscopic submucosal dissection indication

Abstract

Background and study aims: Laparoscopic and endoscopic cooperative surgery (LECS) is a beneficial procedure that enables minimal resection of the gastric wall since the tumor can be located endoscopically. However, it is not indicated for epithelial tumors because of the risk of peritoneal dissemination. Therefore, we devised a new LECS technique, known as sealed endoscopic full-thickness resection (sealed EFTR), in which the serosa was sealed with a silicone sheet to prevent the escape of gastric content and tumor cells. The aims of this study are to evaluate the safety and feasibility of a newly developed procedure, and to observe its long-term outcomes, including absence of local recurrence and peritoneal dissemination. Patients and methods: Approval was obtained from the Ethics Review Committee of the Japan Consortium for Advanced Surgical Endoscopy Study Group. Between December 2011 and July 2021, at Kanazawa Medical University Hospital, 16 patients with cT1 gastric cancer were enrolled in this study. Sealed EFTR was performed in patients diagnosed with negative lymph node metastasis via intraoperative sentinel node biopsy. Results: Among the 16 enrolled patients, 12 (75%) had negative sentinel node metastases, 11 of whom underwent sealed EFTR. Except for two patients who died from other causes, no instances of metastasis or recurrence were observed during the mean follow-up period of 6.5 (2–11) years. Conclusions: This study suggests that appropriate case selection by sentinel lymph node biopsy could allow for oncologically safe and individualized minimally invasive surgery for early gastric cancer that is ineligible for endoscopic submucosal dissection.