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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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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ACKNOWLEDGMENT

This work was supported by a Grant (NCC 1110550-2) from the National Cancer Center, Republic of Korea.

DISCLOSURES

Drs. 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, and Young-Woo, Kim have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang-Si, Gyeonggi-Do, Republic of Korea

    Ji Yeon Park MD, Keun Won Ryu MD, PhD, Bang Wool Eom MD, Hong Man Yoon MD, Soo Jin Kim MD, Soo-Jeong Cho MD, PhD, Jong Yeul Lee MD, Chan Gyoo Kim MD, PhD, Myeong-Cherl Kook MD, PhD, Il Ju Choi MD, PhD & Young-Woo Kim MD, PhD

  2. Cancer Biostatistics Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Goyang-si, Republic of Korea

    Byung Ho Nam PhD

Authors
  1. Ji Yeon Park MD
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  2. Keun Won Ryu MD, PhD
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  3. Bang Wool Eom MD
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  4. Hong Man Yoon MD
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  6. Soo-Jeong Cho MD, PhD
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  7. Jong Yeul Lee MD
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  8. Chan Gyoo Kim MD, PhD
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  9. Myeong-Cherl Kook MD, PhD
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  10. Il Ju Choi MD, PhD
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  11. Byung Ho Nam PhD
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  12. Young-Woo Kim MD, PhD
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Corresponding author

Correspondence to Keun Won Ryu MD, PhD.

Additional information

This work was supported by a Grant (NCC 1110550-2) from the National Cancer Center, Republic of Korea.

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Park, J.Y., Ryu, K.W., Eom, B.W. et al. 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. Ann Surg Oncol 21, 1123–1129 (2014). https://doi.org/10.1245/s10434-013-3427-2

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  • DOI: https://doi.org/10.1245/s10434-013-3427-2

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