Minimally invasive function-preserving gastrectomy with sentinel node biopsy for early gastric cancer

Background: Recently, minimally invasive approaches such as endoscopic treatment or laparoscopic gastrectomy for early gastric cancer have made rapid progress. However, the extent of gastrectomy and lymphadenectomy in laparoscopic surgery is radical, similar to that of open gastrectomy for patients with early gastric cancer diagnosed as not indicated for endoscopic treatment. Since it is well known that lymph node metastasis is an important prognostic factor, the standard procedure of gastrectomy with radical lymph node dissection has been performed for the purpose of curative resection. The frequency of lymph node metastases is relatively low in patients with early gastric cancer; therefore, function-preserving gastrectomy, a solution between endoscopic treatment and standard gastrectomy in terms of invasiveness, could be considered to avoid excessive invasive surgery. Summary: A prospective multicenter trial and meta-analyses of sentinel node (SN) mapping and biopsy for early gastric cancer demonstrated favorable SN detection rates and accuracy of nodal metastatic status. Personalized function-preserving gastrectomy with limited lymphadenectomy using SN theory will positively impact patients' quality of life (QOL). Specifically, a full-thickness partial gastrectomy by laparoscopic endoscopic cooperative surgery with SN basin dissection could become a reliable technique of minimally invasive gastrectomy for treating patients with clinically node-negative (cN0) early gastric cancer. Key Messages: For early gastric cancer, the development of laparoscopic personalized minimized gastrectomy with SN navigation may improve patients' postoperative QOL.