Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2021; 27(46): 8010-8030
Published online Dec 14, 2021. doi: 10.3748/wjg.v27.i46.8010
Life prognosis of sentinel node navigation surgery for early-stage gastric cancer: Outcome of lymphatic basin dissection
Shinichi Kinami, Naohiko Nakamura, Tomoharu Miyashita, Hidekazu Kitakata, Sachio Fushida, Takashi Fujimura, Yasuo Iida, Noriyuki Inaki, Toru Ito, Hiroyuki Takamura
Shinichi Kinami, Naohiko Nakamura, Tomoharu Miyashita, Hiroyuki Takamura, Department of Surgical Oncology, Kanazawa Medical University, Kahoku 920-0293, Ishikawa, Japan
Hidekazu Kitakata, Toru Ito, Department of Gastroenterological Endoscopy, Kanazawa Medical University, Kahoku 920-0293, Ishikawa, Japan
Sachio Fushida, Noriyuki Inaki, Department of Gastrointestinal Surgery, Kanazawa University, Kanazawa 920-8641, Ishikawa, Japan
Takashi Fujimura, Department of Surgery, Toyama City Hospital, Toyama 939-8511, Toyama, Japan
Yasuo Iida, Department of Mathematics, Division of General Education, Kanazawa Medical University, Kahoku 920-0293, Ishikawa, Japan
Author contributions: Kinami S was responsible for the scientific conception of the study and writing of the manuscript; Kinami S, Nakamura N, Miyashita T, Kitakata H, Fushida S, Fujimura T, and Ito T contributed to the surgery and data collection; Iida Y was responsible for the statistical analysis; Takamura H and Inaki N contributed to the drafting, editing, and critical revision of the manuscript; and all authors contributed to the approval of the final version of the manuscript.
Institutional review board statement: This study was approved by the ethics committee of Kanazawa University Hospital and Kanazawa Medical University (Trial Number R093, M288). ICG mapping was approved by the ethics committee of Kanazawa Medical University (Trial Number M404).
Informed consent statement: All patients provided written informed consent for surgery and the use of their data. Regarding data use in the retrospective study, the patients were given the opportunity to opt out of the study at any time.
Conflict-of-interest statement: The authors declare no conflicts of interest related to the publication of this study.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shinichi Kinami, MD, PhD, Professor, Department of Surgical Oncology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku 920-0293, Ishikawa, Japan. kinami@kanazawa-med.ac.jp
Received: May 20, 2021
Peer-review started: May 20, 2021
First decision: June 22, 2021
Revised: June 28, 2021
Accepted: November 29, 2021
Article in press: November 29, 2021
Published online: December 14, 2021
Abstract
BACKGROUND

Lymphatic basin dissection is a sentinel node biopsy method that is specific for gastric cancer. In this method, the dyed lymphatic system is dissected en bloc, and sentinel nodes are identified at the back table (ex vivo). Even with lymphatic basin dissection, blood flow to the residual stomach can be preserved, and function-preserving curative gastrectomy can be performed. The oncological safety of function-preserving curative gastrectomy combined with lymphatic basin dissection has not yet been fully investigated. We hypothesized that the oncological safety of sentinel node navigation surgery (SNNS) is not inferior to that of the guidelines.

AIM

To investigate the life prognosis of SNNS for gastric cancer in comparison with guidelines surgery.

METHODS

This was a retrospective cohort study. Patients were selected from gastric cancer patients who underwent sentinel node biopsy from April 1999 to March 2016. Patients from April 1999 to August 2008 were from the Department of Surgery II, Kanazawa University Hospital, and patients from August 2009 to March 2016 were from the Department of Surgical Oncology, Kanazawa Medical University Hospital. Patients who were diagnosed with gastric cancer, which was preoperatively diagnosed as superficial type (type 0), 5 cm or less in length, clinical T1-2 and node negative, and underwent various gastrectomies guided by sentinel node navigation were retrospectively collected. The overall survival (OS) and relapse-free survival (RFS) of these patients (SNNS group) were investigated. Patients with gastric cancer of the same stage and who underwent guidelines gastrectomy with standard nodal dissection were also selected as the control group.

RESULTS

A total of 239 patients in the SNNS group and 423 patients in the control group were included. Pathological nodal metastasis was observed in 10.5% and 10.4% of the SNNS and control groups, respectively. The diagnostic abilities of sentinel node biopsy were 84% and 98.6% for sensitivity and accuracy, respectively. In the SNNS group, 81.6% of patients underwent modified gastrectomy or function-preserving curative gastrectomy with lymphatic basin dissection, in which the extent of nodal dissection was further reduced compared to the guidelines. The OS rate in the SNNS group was 96.8% at 5 years and was significantly better than 91.3% in the control group (P = 0.0014). The RFS rates were equal in both groups. After propensity score matching, there were 231 patients in both groups, and the cumulative recurrence rate was 0.43% at 5 years in the SNNS group and 1.30% in the control group, which was not statistically different.

CONCLUSION

The oncological safety of patients who undergo gastrectomy guided by sentinel node navigation is not inferior to that of the guidelines surgery.

Keywords: Early gastric cancer, Sentinel node biopsy, Function preserving surgery, Lymph node dissection, Gastrectomy, Lymphatic basin dissection

Core Tip: The oncological safety of 239 patients with early-stage gastric cancer who underwent sentinel node navigation surgery was investigated. In total, 81.6% of patients underwent modified gastrectomy or function-preserving curative gastrectomy with lymphatic basin dissection, and the extent of nodal dissection was reduced compared to the guidelines. The overall survival rate at 5 years was significantly better, and the cumulative recurrence rate was equal to that of the control group in original data sets and propensity score-matched comparisons. The oncological safety of patients undergoing gastrectomy guided by sentinel node navigation is not inferior to that of the guidelines surgery.