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Takeuchi et al. J Cancer Metastasis Treat 2018;4:38 I http://dx.doi.org/10.20517/2394-4722.2017.83 Page 7 of 9

of primary tumor site. After placing circumferential serosal markings laparoscopically, submucosal
injection was endoscopically administered. Next, circumferential seromuscular incision of the primary
tumor and suturing of outer edge of the seromuscular incision were laparoscopically performed, with
the primary lesion inverted to the inside of the stomach. Subsequently, the circumferential mucosal
and submucosal incision of the primary lesion was endoscopically added, and the primary lesion was
perorally removed [Figure 3].

NEWS in combination with laparoscopic SN mapping enables us to minimize the area of gastric resection
as full-thickness partial gastrectomy in patients with SN-negative for metastasis . NEWS does not require
[25]
intentional perforation of the gastric wall during the procedure. Therefore we can apply this technique for
treating gastric cancers without the risk of iatrogenic dissemination of tumor cells into the peritoneum and
abdominal cavity. The NEWS combined with laparoscopic SN mapping are expected to become a promising
minimally invasive, function-preserving gastrectomy to cure cN0 early-stage gastric cancer.

LIMITATION AND FUTURE PERSPECTIVE OF SN NAVIGATION SURGERY
Many single institutional studies and the prospective multicenter trial of SN mapping and biopsy for
early-stage gastric cancer have demonstrated acceptable SN detection rates and accuracy to predict nodal
metastatic status. However, SN mapping techniques in details such as the choice of dyes, dual or single tracer
methods, and the timing of tracer injection need to be standardized for universal application of SN biopsy
in clinical practice. In addition, proper indication of laparoscopic function-preserving gastrectomy such as
laparoscopic local resection with SN navigation surgery based on the tumor location has not been verified yet.
Also, further improvement in SN navigation techniques should be required for more accurate SN mapping.
Results of ongoing Japanese and Korean prospective trials would be expected to verify the postoperative
patients’ QOL and long-term survival in patients undergoing laparoscopic function-preserving gastrectomy
with SN mapping.

CONCLUSION
For early-stage gastric cancer, good prognosis can currently be guaranteed by conventional standard
gastrectomy. However, the personalized, minimally invasive treatments retaining the patients’ QOL have to be
developed as a next step. Although further studies are required for careful evaluation, laparoscopic function-
preserving gastrectomy, such as full-thickness partial gastrectomy, in combination with laparoscopic SN
mapping would become an ideal strategy to reach the goal.

DECLARATIONS
Authors’ contributions
Writing the manuscript: Takeuchi H
Supervising as a primary investigator of the clinical trials in the manuscript: Kitagawa Y

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declare that there are no conflicts of interest.