Combination of endoscopic submucosal dissection and laparoscopic sentinel lymph node dissection in early mucinous gastric cancer: Role of lymph node metastasis

Abstract

BACKGROUND Recent evidence showed that combining endoscopic submucosal dissection (ESD) and laparoscopic sentinel lymph node dissection may avoid unnecessary gastrectomy in treating early mucinous gastric cancer (EMGC) patients with risks of positive lymph node metastasis (pLNM). AIM To explore the predictive factors for pLNM in EMGC, and to optimize the clinical application of combing ESD and sentinel lymph node dissection in a proper subgroup of patients with EMGC. METHODS Thirty-one patients with EMGC who had undergone gastrectomy with lymph node dissection were consecutively enrolled from January 1988 to December 2016. Univariate and multivariate logistic regression analyses were used to estimate the association between the rates of pLNM and clinicopathological factors, providing odds ratio (OR) with 95% confidence interval. And the association between the number of predictors and the pLNM rate was also investigated. RESULTS Depth of invasion (OR = 7.342, 1.127-33.256, P = 0.039), tumor diameter (OR = 9.158, 1.348-29.133, P = 0.044), and lymphatic vessel involvement (OR = 27.749, 1.821-33.143, P = 0.019) turned out to be significant and might be the independent risk factors for predicating pLNM in the multivariate analysis. For patients with 1, 2, and 3 risk factors, the pLNM rates were 9.1%, 33.3%, and 75.0%, respectively. pLNM was not detected in seven patients without any of these risk factors. CONCLUSION ESD might serve as a safe and sufficient treatment for intramucosal EMGC if tumor size ≤ 2 cm, and when lymphatic vessel involvement is absent by postoperative histological examination. Combining ESD and sentinel lymph node dissection could be recommended as a safe and effective treatment for EMGC patients with a potential risk of pLNM.

Prediction of recurrence of early gastric carcinoma after endoscopic submucosal dissection

“…The appearance of positive lymph nodes suggests the metastasis of gastric cancer, and the patients with more positive lymph nodes have severer conditions and higher risks of residual potential cancer cells in the lymphatic system and recurrence of gastric cancer. Additionally, the patients with positive lymph nodes also need lymph node dissection, and the dissection range is positively correlated with the number of positive lymph nodes, thus affecting the postoperative recovery and raising the recurrence risk of gastric cancer 13 . HP infection itself is an independent risk factor for gastric cancer 14 .…”

Choice of LECS Procedure for Benign and Malignant Gastric Tumors

“…This procedure is the same as LAER with LLND, and the concept is to preserve the stomach if submucosal dissection is performed with endoscopy and if LND is performed with laparoscopy [ 28 29 30 31 32 33 ]. The advantage is that the stomach can be preserved; however, the main procedure is ESD, which requires a skilled endoscopist and is time consuming ( Fig.…”