Sentinel node navigation surgery in early-stage gastric carcinoma: a limited gastric resection with lymphatic basin dissection in sentinel node-negative patients

摘要

The high accuracy of sentinel node biopsy in clinical T1 gastric cancer leads to the idea of excluding conventional D2 from node-negative patients. The question now arises of what to do when sentinel nodes are missed during surgery and micrometastases are over looked in frozen tissue sections. To avoid and correct a mistaken diagnosis, surgeons should remove the lymphatic basin even in the case of negative sentinel nodes, because the basin is exclusively associated with the involved nodes. We call this procedure "lymphatic basin dissection." Gastric lymphatic basins were divided into five compartments corresponding to the feeding artery, and clinical T1 gastric cancer involved a single basin in 42% of patients, two in 47% and three in 12%. Patients with one or two basins can be treated with limited gastric resection, because the devascularization does not cause insufficient blood supply to the remnant stomach. Since 1995, 123 patients have undergone lymphatic basin dissection and limited gastric resection (segmental resection, local resection, proximal gastrectomy, and limited distal gastrectomy) in our institution. There was no recurrence in the limited surgery patients with a median follow-up period of 3.8 years. The overall survival curve after surgery in the limited group is almost the same as that in the conventional group. Quality of life was significantly higher in the limited group than in the conventional group.