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Page 4 of 9 Takeuchi et al. J Cancer Metastasis Treat 2018;4:38 I http://dx.doi.org/10.20517/2394-4722.2017.83

cT1 (< 4 cm) N0M0 early gastric cancer

Laparoscopic SN mapping and biopsy
Laparoscopic sentinel lymphatic basin dissection
Intra-operative diagnosis of SN

SN metastasis (-) SN metastasis (+)

Laparoscopic function-preserving gastrectomy Laparoscopic
Partial/wedge resection distal/total gastrectomy
Segmental resection with D2 dissection
Pylorus-preserving gastrectomy
Proximal gastrectomy
Endoscopic submucosal dissection (ESD)

Figure 1. Laparoscopic function-preserving gastrectomy for cT1N0M0 gastric cancer with sentinel node mapping. ESD: endoscopic
submucosal dissection

had a primary tumor more than 4-cm had a metastatic non-SN outside the SN basin . The prospective
[10]
multicenter trial verified that SN mapping for gastric cancer is technically feasible and reliable regarding
SN detection rate and overall accuracy. The study would provide perspectives on the future of minimally
invasive personalized gastrectomy based on SN mapping for early-stage gastric cancer.

MINIMALLY INVASIVE GASTRECTOMY BASED ON SN MAPPING IN EARLY-STAGE GASTRIC
CANCER
Pathological status of SN and distribution of SN basins would provide the information in minimizing the
extent of gastric resection and avoiding distal or total gastrectomy with D2 lymphadenectomy. Laparoscopic
function-preserving gastrectomy for cT1N0 gastric cancers, including partial/wedge resection, segmental
gastrectomy, proximal gastrectomy, and pylorus-preserving gastrectomy would be determined based on
the SN status for each patient [Figure 1] [18-20] . Retention of patients’ QOL in addition to earlier postoperative
recovery could be obtained using laparoscopic minimized gastrectomy with SN mapping.

Ichikura et al. previously reported 35 patients with limited gastrectomy such as wedge resection and
[21]
segmental gastrectomy with SN basin dissection for early gastric cancer with pathologically negative SN
biopsy. As the results showed, all patients could survive without any recurrence of tumor in the study.
Moreover the extent of the resected stomach in patients with limited gastrectomy was significantly less
than that in patients with the standard gastrectomy. Based on these studies, our group in Japan has been
conducting a multicenter prospective trial (UMIN ID: 000014401) which aims to elucidate laparoscopic
function-preserving gastrectomy with SN mapping and SN basin dissection regarding long-term survival and
postoperative patients’ QOL for patients with clinical T1N0M0 gastric cancer with primary lesions of < 4 cm
in tumor diameter. In the study, en-bloc SN basin dissection including SN even in patients with SN-negative
for metastasis is thought to be essential to warrant the curability of the surgery because of certain possibility
of false-negative SN. A Korean group has also been conducting a prospective multicenter randomized
controlled trial to clarify the oncological safety, including long-term survival, of laparoscopic function-
preserving gastrectomy with SN basin dissection compared with laparoscopic standard gastrectomy .
[22]