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http://dx.doi.org/10.5230/jgc.2020.20.e35

Regional Lymph Node Dissection as an Additional Treatment Option to Endoscopic Resection for Expanded Indications in Gastric Cancer: a Prospective Cohort Study  

Seo, Ho Seok (Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Yoo, Han Mo (Division of Gastrointestinal Surgery, Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Jung, Yoon Ju (Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Lee, Sung Hak (Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Park, Jae Myung (Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Song, Kyo Young (Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Jung, Eun Sun (Department of Hospital Pathology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Choi, Myung-Gyu (Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Park, Cho Hyun (Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Publication Information
Journal of Gastric Cancer / v.20, no.4, 2020 , pp. 442-453 More about this Journal
Abstract
Purpose: Expanded indications for endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) remain controversial due to the potential risk of undertreatment after adequate lymph node dissection (LND). Regional LND (RLND) is a novel technique used for limited lymphadenectomy to avoid gastrectomy. This study established the safety and effectiveness of RNLD as an additional treatment option after ESD for expanded indications. Materials and Methods: A total of 69 patients who met the expanded indications for ESD were prospectively enrolled from 2014 to 2017. The tumors were localized using intraoperative esophagogastroduodenoscopy (EGD) before RLND. All patients underwent RLND first, followed by conventional radical gastrectomy with LND. The locations of the preoperative and intraoperative EGD were compared. Pathologic findings of the primary lesion and the RLND status were analyzed. Results: The concordance rates of tumor location between the preoperative and intraoperative EGD were 79.7%, 76.8%, and 63.8% according to the longitudinal, circumferential, and regional locations, respectively. Of the 4 patients (5.7%) with metastatic LNs, 3 were pathologically classified as beyond the expanded indication for ESD and 1 had a single LN metastasis in the regional lymph node. Conclusions: RLND is a safe additional option for the treatment of EGC in patients meeting expanded indications after ESD.
Keywords
Stomach neoplasms; Regional lymph node dissection; Minimally invasive surgical procedures; Endoscopic mucosal resection; Endoscopy;
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