Annals of Surgical Oncology

, Volume 21, Issue 4, pp 1123–1129

Proposal of the Surgical Options for Primary Tumor Control During Sentinel Node Navigation Surgery Based on the Discrepancy Between Preoperative and Postoperative Early Gastric Cancer Diagnoses

  • Ji Yeon Park
  • Keun Won Ryu
  • Bang Wool Eom
  • Hong Man Yoon
  • Soo Jin Kim
  • Soo-Jeong Cho
  • Jong Yeul Lee
  • Chan Gyoo Kim
  • Myeong-Cherl Kook
  • Il Ju Choi
  • Byung Ho Nam
  • Young-Woo Kim
Gastrointestinal Oncology

DOI: 10.1245/s10434-013-3427-2

Cite this article as:
Park, J.Y., Ryu, K.W., Eom, B.W. et al. Ann Surg Oncol (2014) 21: 1123. doi:10.1245/s10434-013-3427-2

Abstract

Background

There is no consensus on the optimal method of primary tumor control, determined by preoperative clinical factors, during sentinel node (SN) navigation surgery for early gastric cancer (EGC). In this study, we investigated the accuracy of clinical diagnosis based on preoperative examination in patients with EGC and proposed surgical options for primary tumor control during SN navigation surgery.

Methods

We analyzed 815 patients with clinical stage IA gastric cancer who underwent gastrectomy at the National Cancer Center in Korea between March 2001 and February 2011. The clinical stage was determined by endoscopy, endoscopic ultrasonography, and abdominal computed tomography.

Results

The preoperative assessment of tumor depth and tumor size was accurate in 57.5 and 70.8 % of patients, respectively. Tumor depth and size were underestimated in 8 and 25.3 % of patients. The overall accuracy of histologic diagnosis by endoscopic biopsy was 87.2 %. Of those tumors diagnosed preoperatively as differentiated, 20.5 % revealed mixed histology of undifferentiated type.

Conclusions

The recommendation for SN biopsy may be limited to tumors sized 3 cm or smaller to avoid positive lateral margins and to minimize the risk of skip metastases. Endoscopic resection may safely be applied to small mucosal cancers, but other surgical options should be employed for undifferentiated large mucosal lesions, given their tendency for diffuse invasion. Full-thickness resection is preferable for submucosal cancers, to secure clear vertical margins.

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Ji Yeon Park
    • 1
  • Keun Won Ryu
    • 1
  • Bang Wool Eom
    • 1
  • Hong Man Yoon
    • 1
  • Soo Jin Kim
    • 1
  • Soo-Jeong Cho
    • 1
  • Jong Yeul Lee
    • 1
  • Chan Gyoo Kim
    • 1
  • Myeong-Cherl Kook
    • 1
  • Il Ju Choi
    • 1
  • Byung Ho Nam
    • 2
  • Young-Woo Kim
    • 1
  1. 1.Gastric Cancer Branch, Research Institute & HospitalNational Cancer CenterGoyang-SiRepublic of Korea
  2. 2.Cancer Biostatistics Branch, Research Institute for National Cancer Control & EvaluationNational Cancer CenterGoyang-siRepublic of Korea