Abstract
Background
Endoscopic full-thickness gastric resection (EFTGR) with regional lymph node dissection (LND) has been used for early gastric cancer (EGC) exceeding the indications for endoscopic submucosal dissection (ESD). The extent of the dissected lymph nodes is crucial. A 3D near-infrared (NIR) video robot system significantly enhances visualization of the lymphatic system. However, this system has not been used in EFTGR with LND. Thus, this study assessed the benefits of the 3D NIR video robot system in a clinical setting.
Methods
Between February 2015 and September 2018, 24 patients with EGC exceeding the indications for ESD were treated with EFTGR and LND using a 3D NIR video system with the da Vinci surgical robot. Indocyanine green (ICG) was injected endoscopically around the tumor, and basin node (BN) dissection around the nodes was examined using the 3D NIR video system of the da Vinci Si surgical robot. Subsequently, robot-assisted EFTGR was performed. The primary outcome was the 5-year survival rate.
Result
During a 5-year follow-up of all 24 patients, an 80-year-old patient with an ulcer and T2 invasion was lost to follow-up. Among the remaining 23 patients, no mortality or recurrence was observed.
Conclusion
No metastasis or mortality occurred using the da Vinci robot-assisted EFTGR with LLND and a 3D NIR video system for patients who required radical gastrectomy for EGC in over 5 years. Hence, this may be a safe and effective method for radical gastrectomy; further studies are required confirming its effectiveness.
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References
Kim MY, Cho JH, Cho JY (2014) Ever-changing endoscopic treatment for early gastric cancer: yesterday-today-tomorrow. World J Gastroenterol 20(37):13273–13283
Gotoda T (2007) Endoscopic resection of early gastric cancer. Gastric Cancer 10(1):1–11
Japanese Gastric Cancer Association (2023) Japanese gastric cancer treatment guidelines 2021 (6th edition). Gastric Cancer 26:1–25
Jeong U, Bang HY, Kim PS (2021) Clinical significance of additional gastrectomy after non-curative endoscopic submucosal dissection for early gastric cancer: a retrospective single-center study. Korean J Clin Oncol 17(2):68–72
Cho WY, Kim YJ, Cho JY, Bok GH, Jin SY, Lee TH, Kim HG, Kim JO, Lee JS (2011) Hybrid natural orifice transluminal endoscopic surgery: endoscopic full-thickness resection of early gastric cancer and laparoscopic regional lymph node dissection—14 human cases. Endoscopy 43(2):134–139
Lee JH, Ryu KW, Kook MC, Lee JY, Kim CG, Choi IJ, Kim SK, Jang S, Park SR, Kim YW, Nam BH, Bae JM (2008) Feasibility of laparoscopic sentinel basin dissection for limited resection in early gastric cancer. J Surg Oncol 98(5):331–335
Alander JT, Kaartinen I, Laakso A, Pätilä T, Spillmann T, Tuchin VV, Venermo M, Välisuo P (2012) A review of indocyanine green fluorescent imaging in surgery. Int J Biomed Imaging 2012:940585
Chen QY, Xie JW, Zhong Q, Wang JB, Lin JX, Lu J, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Li P, Zheng CH, Huang CM (2020) Safety and efficacy of indocyanine green tracer-guided lymph node dissection during laparoscopic radical gastrectomy in patients with gastric cancer: a randomized clinical trial. JAMA Surg 155(4):300–311
Kinami S, Oonishi T, Fujita J, Tomita Y, Funaki H, Fujita H, Nakano Y, Ueda N, Kosaka T (2016) Optimal settings and accuracy of indocyanine green fluorescence imaging for sentinel node biopsy in early gastric cancer. Oncol Lett 11(6):4055–4062
Lee YJ, Jeong SH, Hur H, Han SU, Min JS, An JY, Hyung WJ, Cho GS, Jeong GA, Jeong O, Park YK, Jung MR, Kim YW, Yoon HM, Eom BW, Park JY, Ryu KW; Sentinel Node Oriented Tailored Approach (SENORITA) Study Group (2015) Prospective multicenter feasibility study of laparoscopic sentinel basin dissection for organ preserving surgery in gastric cancer: quality control study for surgical standardization prior to Phase III trial. Medicine (Baltim) 94(45):e1894
Vahrmeijer AL, Hutteman M, van der Vorst JR, van de Velde CJH, Frangioni JV (2013) Image-guided cancer surgery using near-infrared fluorescence. Nat Rev Clin Oncol 10(9):507–518
Kim H, Lee SK, Kim YM, Lee EH, Lim SJ, Kim SH, Yang J, Lim JS, Hyung WJ (2015) Fluorescent iodized emulsion for pre- and intraoperative sentinel lymph node imaging: validation in a preclinical model. Radiology 275(1):196–204
Tajima Y, Yamazaki K, Masuda Y, Kato M, Yasuda D, Aoki T, Kato T, Murakami M, Miwa M, Kusano M (2009) Sentinel node mapping guided by indocyanine green fluorescence imaging in gastric cancer. Ann Surg 249(1):58–62
Kwon IG, Son T, Kim HI, Hyung WJ (2019) Fluorescent lymphography-guided lymphadenectomy during robotic radical gastrectomy for gastric cancer. JAMA Surg 154(2):150–158
Osterkamp J, Strandby R, Nerup N, Svendsen MB, Svendsen LB, Achiam M (2023) Intraoperative near-infrared lymphography with indocyanine green may aid lymph node dissection during robot-assisted resection of gastroesophageal junction cancer. Surg Endosc 37(3):1985–1993
Kitagawa Y, Takeuchi H, Takagi Y, Natsugoe S, Terashima M, Murakami N, Fujimura T, Tsujimoto H, Hayashi H, Yoshimizu N, Takagane A, Mohri Y, Nabeshima K, Uenosono Y, Kinami S, Sakamoto J, Morita S, Aikou T, Miwa K, Kitajima M (2013) Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol 31(29):3704–3710
Baral S, Arawker MH, Sun Q, Jiang M, Wang L, Wang Y, Ali M, Wang D (2022) Robotic versus laparoscopic gastrectomy for gastric cancer: a mega meta-analysis. Front Surg 9:895976
Song WC, Qiao XL, Gao XZ (2015) A comparison of endoscopic submucosal dissection (ESD) and radical surgery for early gastric cancer: a retrospective study. World J Surg Oncol 13:309
Bok GH, Kim YJ, Jin SY, Chun CG, Lee TH, Kim HG, Jeon SR, Cho JY (2012) Endoscopic submucosal dissection with sentinel node navigation surgery for early gastric cancer. Endoscopy 44(10):953–956
Ko WJ, Kim YM, Yoo IK, Cho JY (2018) Clinical outcomes of minimally invasive treatment for early gastric cancer in patients beyond the indications of endoscopic submucosal dissection. Surg Endosc 32(9):3798–3805
Goto O, Takeuchi H, Kitagawa Y, Yahagi N (2016) Hybrid surgery for early gastric cancer. Transl Gastroenterol Hepatol 1:26
Eom BW, Yoon HM, Min JS, Cho I, Park JH, Jung MR, Hur H, Kim YW, Park YK, Nam BH, Ryu KW; Sentinel Node Oriented Tailored Approach (SENORITA) Study Group (2019) Prospective multicenter feasibility study of laparoscopic sentinel basin dissection after endoscopic submucosal dissection for early gastric cancer: SENORITA 2 trial protocol. J Gastric Cancer 19(2):157–164
Lee SE, Lee JH, Ryu KW, Cho SJ, Lee JY, Kim CG, Choi IJ, Kook MC, Nam BH, Park SR, Lee JS, Kim YW (2009) Sentinel node mapping and skip metastases in patients with early gastric cancer. Ann Surg Oncol 16(3):603–608
Miyashiro I, Hiratsuka M, Sasako M, Sano T, Mizusawa J, Nakamura K, Nashimoto A, Tsuburaya A, Fukushima N, Gastric Cancer Surgical Study Group (GCSSG) in the Japan Clinical Oncology Group (JCOG) (2014) High false-negative proportion of intraoperative histological examination as a serious problem for clinical application of sentinel node biopsy for early gastric cancer: final results of the Japan Clinical Oncology Group multicenter trial JCOG0302. Gastric Cancer 17(2):316–323
Son T, Hyung WJ, Lee JH, Kim YM, Kim HI, An JY, Cheong JH, Noh SH (2012) Clinical implication of an insufficient number of examined lymph nodes after curative resection for gastric cancer. Cancer 118(19):4687–4693
Okholm C, Svendsen LB, Achiam MP (2014) Status and prognosis of lymph node metastasis in patients with cardia cancer—a systematic review. Surg Oncol 23(3):140–146
Ikehara H, Gotoda T, Ono H, Oda I, Saito D (2007) Gastric perforation during endoscopic resection for gastric carcinoma and the risk of peritoneal dissemination. Br J Surg 94(8):992–995
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Ah Young Lee, Min Chan Kim, Sungwoo Cho, In Kyung Yoo, Yoo Min Kim, Tae Hee Lee, Jun-Young Seo, Seong Hwan Kim, Joo Young Cho, have no conflict of interest or financial ties to disclose.
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Appendix
Appendix
Five-year postoperative clinical outcomes
Da Vinci robot-assisted EFTGR with LLND (n = 24) | Conventional EFTGR with LLND (n = 28) | |
---|---|---|
Local recurrence, n (%) | 0 (0) | 1 (3.6) |
Distant metastasis, n (%) | 0 (0) | 0 (0) |
Death, n (%) | 0 (0) | 1 (3.6) |
Follow-up loss, n (%) | 1 (4.2) | 2 (7.2) |
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Lee, A.Y., Kim, M.C., Cho, S. et al. Da Vinci robot-assisted endoscopic full-thickness gastric resection with regional lymph node dissection using a 3D near-infrared video system: a single-center 5-year clinical outcome. Surg Endosc 38, 2124–2133 (2024). https://doi.org/10.1007/s00464-024-10722-0
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DOI: https://doi.org/10.1007/s00464-024-10722-0