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Laparoscopy-assisted Proximal Gastrectomy with Sentinel Node Mapping for Early Gastric Cancer
World Journal of Surgery, 09/09/2011
Takeuchi H et al. – This study reveals that authors' novel laparoscopy–assisted proximal gastrectomy (LAPG) approach is curative and represents a feasible minimally invasive surgical procedure with minimal morbidity and postoperative reflux esophagitis in patients with upper–third early–stage gastric cancer.
Methods- 37 consecutive patients who were preoperatively diagnosed with cT1N0M0 primary gastric cancer in the upper third of the stomach with the primary tumor diameter less than 4 cm were enrolled.
- Laparoscopy-assisted proximal gastrectomy with sentinel node (SN) mapping and esophagogastric anastomosis with a circular stapler and transoral placement of the anvil was attempted.
- The LAPG procedure was completed in 36 patients.
- It was converted to laparoscopy-assisted total gastrectomy in one patient because one SN detected intraoperatively was positive for metastasis by intraoperative pathological diagnosis.
- There were no severe postoperative complications in any patient.
- Only one patient (3%) complained of mild reflux symptoms immediately after operation, which were graded endoscopically as B by the Los Angeles Classification of gastroesophageal reflux disease; however, the symptoms were controlled well by a proton-pump inhibitor.
- Sentinel nodes were detected successfully in 37 (100%) of authors' patients.
- The mean number of dissected lymph nodes and identified SNs per case was 29.7 and 5.8, respectively.
- The sensitivity of prediction of nodal metastasis (including isolated tumor cells) and diagnostic accuracy based on SN status were 100% (3/3) and 100% (37/37), respectively.
- All patients have been free from recurrence for a median follow-up period of 26 months.