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

TL;DR

A new surgical technique called sealed EFTR was developed for early gastric cancer, offering a safe and minimally invasive option with no recurrence observed in long-term follow-up.

Contribution

The novel sealed EFTR technique prevents tumor cell escape by sealing the serosa with a silicone sheet during surgery.

Findings

Sealed EFTR showed no metastasis or recurrence in 11 patients over a mean follow-up of 6.5 years.

Sentinel node biopsy helped identify suitable candidates for the procedure, ensuring oncological safety.

The technique provides a minimally invasive alternative for early gastric cancer ineligible for endoscopic submucosal dissection.

Abstract

Laparoscopic and endoscopic cooperative surgery (LECS) is a beneficial procedure that enables minimal resection of the gastric wall because the tumor can be located endoscopically. However, it is not indicated for epithelial tumors because of 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 escape of gastric contents and tumor cells. The aims of this study were 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.

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.

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 years (range, 2–11).

This study suggests that appropriate case selection for 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.

Figures