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

Osamu Goto, Hiroya Takeuchi, Hirofumi Kawakubo, Motoki Sasaki, Tatsuo Matsuda, Satoru Matsuda, Yu Kigasawa, Yoshie Kadota, Ai Fujimoto, Yasutoshi Ochiai, Joichiro Horii, Toshio Uraoka, Yuukou Kitagawa, Naohisa Yahagi

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Introduction Non-exposed endoscopic wall-inversion surgery (NEWS) is a novel technique of endoscopic full-thickness 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.

Original languageEnglish
JournalGastric Cancer
DOIs
Publication statusAccepted/In press - 2014 Aug 3

Fingerprint

Stomach Neoplasms
Dissection
Stomach
Neoplasm Metastasis
Indocyanine Green
Gastrectomy
cyhalothrin
Informed Consent
Arteries
Lymph Nodes
Safety
Injections

Keywords

  • Early gastric cancer
  • Local resection
  • Minimally invasive surgery
  • Sentinel node navigation surgery

ASJC Scopus subject areas

  • Cancer Research
  • Gastroenterology
  • Oncology

Cite this

First case of non-exposed endoscopic wall-inversion surgery with sentinel node basin dissection for early gastric cancer. / Goto, Osamu; Takeuchi, Hiroya; Kawakubo, Hirofumi; Sasaki, Motoki; Matsuda, Tatsuo; Matsuda, Satoru; Kigasawa, Yu; Kadota, Yoshie; Fujimoto, Ai; Ochiai, Yasutoshi; Horii, Joichiro; Uraoka, Toshio; Kitagawa, Yuukou; Yahagi, Naohisa.

In: Gastric Cancer, 03.08.2014.

Research output: Contribution to journalArticle

Goto, Osamu ; Takeuchi, Hiroya ; Kawakubo, Hirofumi ; Sasaki, Motoki ; Matsuda, Tatsuo ; Matsuda, Satoru ; Kigasawa, Yu ; Kadota, Yoshie ; Fujimoto, Ai ; Ochiai, Yasutoshi ; Horii, Joichiro ; Uraoka, Toshio ; Kitagawa, Yuukou ; Yahagi, Naohisa. / First case of non-exposed endoscopic wall-inversion surgery with sentinel node basin dissection for early gastric cancer. In: Gastric Cancer. 2014.
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abstract = "Introduction Non-exposed endoscopic wall-inversion surgery (NEWS) is a novel technique of endoscopic full-thickness 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.",
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AU - Goto, Osamu

AU - Takeuchi, Hiroya

AU - Kawakubo, Hirofumi

AU - Sasaki, Motoki

AU - Matsuda, Tatsuo

AU - Matsuda, Satoru

AU - Kigasawa, Yu

AU - Kadota, Yoshie

AU - Fujimoto, Ai

AU - Ochiai, Yasutoshi

AU - Horii, Joichiro

AU - Uraoka, Toshio

AU - Kitagawa, Yuukou

AU - Yahagi, Naohisa

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Y1 - 2014/8/3

N2 - Introduction Non-exposed endoscopic wall-inversion surgery (NEWS) is a novel technique of endoscopic full-thickness 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.

AB - Introduction Non-exposed endoscopic wall-inversion surgery (NEWS) is a novel technique of endoscopic full-thickness 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.

KW - Early gastric cancer

KW - Local resection

KW - Minimally invasive surgery

KW - Sentinel node navigation surgery

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