First case of non-exposed endoscopic wall-inversion surgery with sentinel node basin dissection for early gastric cancer

Abstract

Introduction Non-exposed endoscopic wall-inversion surgery (NEWS) is a novel technique of endoscopic fullthickness resection without transluminal access mainly designed to treat gastric cancer. Here, we report a successful case of NEWS with sentinel node basin dissection (SNBD) for early gastric cancer (EGC) with the risk of lymph node metastasis. Patient and methods A 55-year-old female patient with a 2-cm, diffuse-type intramucosal EGC with ulceration was referred to our hospital for a less invasive gastrectomy based on sentinel node navigation surgery. After obtaining informed consent, NEWS with SNBD was applied. After placing mucosal markings, indocyanine green solution was injected endoscopically into the submucosa around the lesion to examine sentinel nodes (SNs). The SN basin (the area of the left gastric artery), including three stained SNs(#3), was dissected, and an intraoperative pathological diagnosis confirmed that no metastasis had occurred. Subsequently, NEWS was performed for the primary lesion. Serosal markings were placed laparoscopically, submucosal injection was added endoscopically, and circumferential sero-muscular incision and suturing were performed laparoscopically, with the lesion inverted toward the inside of the stomach. Finally, the circumferential mucosal incision was performed, and the lesion was retrieved perorally. Results The operation was finished in 270 min without complications. The patient was uneventfully discharged 10 days after the procedure. The final pathological diagnosis was coincident with the pre-and intraoperative assessment. Conclusions We demonstrated the feasibility and safety of NEWS with SNBD with a favorable result. This surgical concept is expected to become a promising, minimally invasive, function-preserving surgery to cure cases of EGC that are possibly node-positive.

Estimation of subepithelial lateral extent in submucosal early gastric cancer: retrospective histological analysis

“…Accordingly, the area of lymph node dissection should be minimized in order to perform EFTR of possibly nodepositive EGC. In the current situation, NEWS with sentinel node basin dissection is thought to be one of most feasible concepts for minimally invasive gastrectomy among the available methods of surgery for those EGCs [11,12]. In this technique, if sentinel nodes identified by a radioactive tracer and/or dye solution reveal no metastasis by intraoperative pathological investigation, the area of lymphadenectomy can be limited to a sentinel node basin and, therefore, the resection area of the primary lesion can also be minimized as much as possible [15].…”

“…20130446), we conducted a retrospective analysis in surgically resected submucosal EGCs between January 2009 and June 2013. In the 108 cases, 69 completely resected EGCs 4 cm or smaller, which could be candidates for NEWS combined with sentinel node navigation surgery as a new concept of minimally invasive gastrectomy of possibly node-positive EGC [11,12], were selected. Of those, nine cases were excluded owing to insufficient preparation slides or lack of information on how to cut the specimen.…”

Nonexposure laparoscopic and endoscopic cooperative surgery (closed laparoscopic and endoscopic cooperative surgery) for gastric submucosal tumor

“…To avoid this problem, some modified LECS procedures have been investigated, such as inverted LECS [7], a combination of laparoscopic and endoscopic approaches to neoplasia with a nonexposure technique (CLEAN-NET) [8], nonexposed endoscopic wall-inversion surgery (NEWS) [9][10][11][12][13], and endoscopic full-thickness resection [14]. Here we introduce a small series of patients with gastric SMT treated by a novel nonexposure technique, termed ''closed LECS.…”

Clinical significance of the anterosuperior lymph nodes along the common hepatic artery identified by sentinel node mapping in patients with gastric cancer

“…We think this visual information will be important to analyze lymphatics. Currently, we have been using ICG fluorescence imaging to visualize lymphatic pathways in addition to detecting SN with radioisotope and blue dye [9,21]. We have observed a case in which we visualized lymphatic pathways from the r-GEA or l-GA basin toward the direction of LN No.…”