• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Humans
• Sentinel Lymph Node Biopsy/methods
• Gastrectomy/methods
• Sentinel Lymph Node/pathology
• Sentinel Lymph Node/surgery
• Lymph Node Excision/methods
• Lymphatic Metastasis

• albumin
• fluorescence imaging
• image-guided surgery
• indocyanine green
• near-infrared
• single-photon emission computed tomography

• Humans
• Animals
• Rats
• Sentinel Lymph Node/diagnostic imaging
• Sentinel Lymph Node/surgery
• Sentinel Lymph Node/pathology
• Sentinel Lymph Node Biopsy/methods
• Lymph Nodes/pathology
• Indocyanine Green
• Tomography, Emission-Computed, Single-Photon
• Radiopharmaceuticals
• Optical Imaging/methods
• Serum Albumin, Human
• Colloids
• Sulfur
• Coloring Agents

• Early gastric cancer
• Lymph node metastasis
• Mucosal cancer
• Submucosal cancer

• Gastric cancer
• Minimally invasive surgery
• Sentinel lymph node

Near-infrared fluorescence imaging with indocyanine green is an emerging technology gaining clinical relevance in the field of oncosurgery. In recent decades, it has also been applied in gastric cancer surgery, spreading among surgeons thanks to the diffusion of minimally invasive approaches and the related development of new optic tools. Its most relevant uses in gastric cancer surgery are sentinel node navigation surgery, lymph node mapping during lymphadenectomy, assessment of vascular anatomy, and assessment of anastomotic perfusion. There is still debate regarding the most effective application, but with relatively no collateral effects and without compromising the operative time, indocyanine green fluorescence imaging carved out a role for itself in gastric resections. This review aims to summarize the current indications and evidence for the use of this tool, including the relevant practical details such as dosages and times of administration.

• function-preserving
• gastric cancer
• sentinel node

• clinical trial
• phase III
• precision medicine
• sentinel lymph node
• stomach neoplasms

• Autism Spectrum Disorder/diagnostic imaging
• Autistic Disorder/diagnostic imaging
• Brain/diagnostic imaging
• Brain Mapping
• Default Mode Network
• Humans
• Magnetic Resonance Imaging
• Neural Pathways

• Sentinel node
• gastric cancer
• minimally invasive surgery

• Early gastric cancer
• Endoscopic mucosal resection
• Endoscopic submucosal dissection
• Sentinel lymph node

• Adult
• Aged
• Aged, 80 and over
• Early Detection of Cancer/methods
• Female
• Follow-Up Studies
• Gastrectomy/methods
• Gastroscopy/methods
• Humans
• Lymph Node Excision/methods
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Sentinel Lymph Node/pathology
• Sentinel Lymph Node/surgery
• Sentinel Lymph Node Biopsy/methods
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery

Gastric cancer that mimics a submucosal tumor (SMT) is infrequently encountered in routine clinical settings, and histopathological analysis is often negative for malignant cells. In such cases, excisional biopsy of the entire tumor may be necessary to make a definitive pathological diagnosis, and laparoscopic and endoscopic cooperative surgery (LECS) is a viable method of excisional biopsy.

An 80-year-old male patient diagnosed with stomach wall irregularities at routine medical check-up was referred to our facility, and consequent endoscopic examination detected a 20-mm protruded lesion in the greater curvature at the middle third of the stomach. Endoscopic ultrasound (EUS) showed a thick, low echoic lesion with an irregular margin in the second layer of the gastric wall. Further, a nodular part of the lesion had infiltrated into the submucosa, with an appearance similar to that of linitis plastica of the stomach. The lesion was highly suspected to be a gastric carcinoma with submucosal invasion. However, mucosal-incision-assisted biopsy revealed no malignant cells. Computed tomography (CT) identified no metastatic lymph nodes. Therefore, an excisional biopsy using LECS was performed, and to avoid peritoneal dissemination, we used a modified version, namely, combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET). The procedure ended without any complications, and post-operative course was uneventful. As histopathology returned a diagnosis of adenocarcinoma pT4a, we performed radical gastrectomy and D2 lymphadenectomy. Post-operative course was unremarkable and the patient underwent follow-up examinations without adjuvant chemotherapy because of old age.

Local resection using LECS for gastric tumors with a high suspicion of malignancy is useful and feasible. LECS could be used in similar cases.

• Gastric cancer
• Gastric cancer simulating SMT
• LECS

• Gastrectomy
• Gastric cancer
• Histopathology
• OSNA assay
• Sentinel node mapping

• Endoscopic mucosal resection
• Sentinel lymph node biopsy
• Stomach neoplasms

New laparoscopic sentinel lymph node navigation using a dedicated magnetic probe and magnetic nanoparticle tracer for gastric cancer patients allows minimally invasive surgeries. By identifying the sentinel lymph nodes containing magnetic nanoparticles, patients can avoid excessive lymph node extraction without nuclear facilities and radiation exposure. This paper describes the development of the laparoscopic magnetic probe, ACDC-probe, for laparoscopic sentinel lymph node identification utilizing the nonlinear response of the magnetic nanoparticles magnetized by an alternating magnetic field with a static magnetic field. For highly sensitive detection, the ratio of static to alternating magnetic fields was optimized to approximately 5. The longitudinal detection length was approximately 10 mm for 140 μg of iron, and the detectable amount of iron was approximately 280 ng at a distance of 1 mm. To demonstrate the feasibility of laparoscopic detection using the ACDC-probe and magnetic tracers, an experiment was performed on a wild swine. The gastric sentinel lymph node was clearly identified during laparoscopic navigation. These results suggest that the newly developed ACDC-probe is useful for laparoscopic sentinel lymph node detection and this magnetic technique appears to be a promising method for future sentinel lymph node navigation of gastric cancer patients.

• curability
• early gastric cancer
• endoscopic resection
• guidelines
• indication

• Gastric cancer
• Sentinel lymph node

• Early gastric cancer
• Endoscopic submucosal resection
• Innovation
• Sentinel lymph node

• Canine model
• Gastric motility
• Regional lymphadenectomy

Background: To evaluate whether radiomic feature-based computed tomography (CT) imaging signatures allow prediction of lymph node (LN) metastasis in gastric cancer (GC) and to develop a preoperative nomogram for predicting LN status.

Methods: We retrospectively analyzed radiomics features of CT images in 1,689 consecutive patients from three cancer centers. The prediction model was developed in the training cohort and validated in internal and external validation cohorts. Lasso regression model was utilized to select features and build radiomics signature. Multivariable logistic regression analysis was utilized to develop the model. We integrated the radiomics signature, clinical T and N stage, and other independent clinicopathologic variables, and this was presented as a radiomics nomogram. The performance of the nomogram was assessed with calibration, discrimination, and clinical usefulness.

Results: The radiomics signature was significantly associated with pathological LN stage in training and validation cohorts. Multivariable logistic analysis found the radiomics signature was an independent predictor of LN metastasis. The nomogram showed good discrimination and calibration.

Conclusions: The newly developed radiomic signature was a powerful predictor of LN metastasis and the radiomics nomogram could facilitate the preoperative individualized prediction of LN status.

• gastric cancer
• lymph node metastasis
• nomogram
• prediction
• radiomics

In our previous study, transumbilical endoscopic submucosal dissection (TU-ESD) was revealed to be feasible, but delayed gastric perforation was observed in 30% of ESD sites. In this study, we aimed to verify locations at which it is feasible to perform TU-ESD in the upper gastric body and to demonstrate the safety of TU-ESD in single-basin lymph node dissection (SBLND).

In vitro, TU-ESD was performed at three lesion sites (anterior wall, AW; posterior wall, PW; and lesser curvature, LC) in each porcine stomach using an EASIE-R tray (cases = 10). In vivo, TU-ESD was performed with SBLND in 9 pigs. Seven days after the operation, the pigs were sacrificed and examined.

In the in vitro feasibility study, the TU-ESD time was significantly faster in the PW group (5.9 ± 2.0 min) than in the LC group (8.5 ± 1.5 min) (p < 0.05) in all 10 cases. In the in vivo survival study, TU-ESD with SBLND was successfully performed without any complications (N = 9). There were no cases of delayed perforation, and healing ulcers were found in all pigs 7 days after the operation. Ulcer size (5.2 ± 3.5 cm²) was approximately 36% smaller than that observed at the ESD operation site (8.1 ± 1.9 cm²) (p = 0.05). Epithelialization in the margin and healing of the gastric ulcers were confirmed by microscopy.

TU-ESD with SBLND is a feasible and safe method. The upper posterior gastric body could be the most feasible location for performing TU-ESD, perhaps because of the difference in the subcutaneous dissection time.

• Endoscope
• Endoscopic submucosal dissection
• Gastric neoplasm
• Laparoscopy
• Porcine
• Single-port surgery

• Early gastric cancer
• Local resection
• Minimally invasive surgery
• Sentinel node navigation surgery

• Adenocarcinoma/pathology
• Adenocarcinoma/surgery
• Adult
• Aged
• Female
• Gastrectomy/methods
• Gastroscopy
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Sentinel Lymph Node Biopsy/methods
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery

Gastric cancer patients represent a rather divergent patient group and in certain carefully selected cases of early forms of gastric cancer the D2 gastrectomy could be considered a more radical procedure than the biological and oncological characteristics of the primary tumor on the gastric wall would require. As any unnecessary dissection increases morbidity without always respective survival benefits, an approach that could accurately predict and actually dictate the exact extent of lymph node dissection would be ideal. It is more than logical the assumption that the standard D2 lymphadenectomy could represent an overtreatment in distinct patients groups such as patients with early gastric cancer with favorable pathological characteristics and clinically negative nodes not suitable for endoscopic treatment because this early stage disease shows limited lymph node metastasis incidence and excellent overall survival. Considering that the D2 gastrectomy has a negative impact on the quality of life of gastric cancer patients due to the post-gastrectomy functional results, a concept of a more targeted lymph node dissection, when appropriate, is certainly appealing. It is yet to be proven whether sentinel lymph node navigation surgery can fulfill such expectations providing the appropriate balance between morbidity and oncological safety in selected gastric cancer patients.

• gastrectomy
• gastric cancer
• laparoscopic assisted gastrectomy
• lymphadenectomy
• sentinel node

• Gastrectomy
• Sentinel lymph node biopsy
• Stomach neoplasms

• Early gastric cancer
• ICG fluorescent signal intensity
• Sentinel node navigation surgery

• Adult
• Aged
• Coloring Agents
• Early Detection of Cancer
• Feasibility Studies
• Female
• Fluorescence
• Humans
• Indocyanine Green
• Lymphatic Metastasis
• Male
• Middle Aged
• Pilot Projects
• Sensitivity and Specificity
• Sentinel Lymph Node/pathology
• Sentinel Lymph Node Biopsy/methods
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery

• Esophageal cancer
• Gastric cancer
• Sentinel node

• Early Detection of Cancer
• Gastrectomy
• Gastrointestinal Neoplasms/diagnosis
• Gastrointestinal Neoplasms/pathology
• Gastrointestinal Neoplasms/surgery
• Humans
• Lymph Node Excision
• Lymphatic Metastasis/diagnosis
• Lymphatic Metastasis/pathology
• Sentinel Lymph Node/pathology
• Sentinel Lymph Node/surgery
• Sentinel Lymph Node Biopsy

Esophageal cancer is one of the leading causes of cancer-related death worldwide. Surgery plays an important role in the treatment strategies for esophageal cancer. Recent advances in surgical techniques and perioperative management have dramatically improved the mortality rate; however, esophagectomy remains a highly invasive procedure that can lead to severe postoperative complications. Future advances in thoracoscopic surgery with the development of surgical endoscopy systems such as three-dimensional (3D) imaging systems with a 4K ultra high-definition camera or two-dimensional (2D) imaging systems with an 8K camera, which is expected to provide 3D-like visual sensation, will enable us to further understand the microscopic anatomy of the thoracic cavity and mediastinum, and to perform delicate surgical procedures that enable minimally invasive esophagectomy with mediastinal lymphadenectomy. A robot-assisted thoracoscopic esophagectomy is attractive for surgeons and may be beneficial to esophageal cancer patients. Preoperative simulation and intraoperative real-time navigation are expected to further help surgeons safely perform esophagectomy with lymphadenectomy. Reduction of the lymphadenectomy field and setting of lymphadenectomy areas with highest priority may be feasible when sentinel node (SN) navigation is appropriately performed in cN0 early-stage esophageal cancer. These technical advances are expected to decrease the morbidity and mortality rate of surgery for esophageal cancer and hopefully improve oncological outcomes.

• esophagectomy
• minimally invasive surgery
• navigation
• sentinel node
• simulation

Laparoscopic and endoscopic cooperative surgery (LECS) was performed for the local resection of gastrointestinal stromal tumors (GIST). LECS enables less resection of the lesion area and preserves function. Furthermore, LECS can be safely performed and independent of tumor location. However, LECS is not usually used for cases involving gastric carcinoma because it may seed tumor cells into the peritoneal cavity when the gastric wall is perforated. Here, we report seven cases of LECS for intra-mucosal gastric carcinoma, which were difficult to carry out by endoscopic submucosal dissection (ESD) because of ulcer scars.

We performed LECS (classical LECS and inverted LECS) in seven cases of intra-mucosal gastric carcinoma. All cases had ulcer scars beside the tumor. LECS was chosen because ESD was thought to be difficult because of the ulcer scars. We only selected cases in which the patients did not prefer gastrectomy and endoscopic examination was indicative of intra-mucosal gastric carcinoma.

In all cases, LECS was performed without severe complications including postoperative stenosis. Histopathology findings proved that the tumors were intra-mucosal carcinoma and had been resected completely. Furthermore, there were ulcer scars (Ul IIIs-IVs) beside the tumor. Currently, dissemination and recurrence have not been apparent.

LECS for intra-mucosal gastric carcinoma is an efficient procedure, but strict observation is necessary because of the possibility of peritoneal dissemination. Results suggest that LECS is likely to be effective for cases involving intra-mucosal gastric carcinoma that are difficult to treat by ESD due to ulcer scars.

• Endoscopic submucosal dissection (ESD)
• Gastric carcinoma
• Laparoscopic and endoscopic cooperative surgery (LECS)
• Ulcer scar

• Colorectal cancer
• Gastric cancer
• Tumor deposits

To identify risk factors for lymph node metastasis using a nomogram for gastric cancer patients to predict lymph node metastasis.

The Chi-square test and the logistic regression showed that the Boarrmann type, preoperative CA199 level, T stage and N stage by CT scan were independent risk factors. The concordance index (C-index) was 0.786 in the internal validation of the Nomogram model. In the external validation, the C-index was 0.809, and the AUC was 0.894. The total accuracy of the prediction was 82.2%, and the false-negative rate was 5.4% with a cut-off value set at 0.109.

The study consisted of 451 patients with a histological diagnosis of gastric cancer with 0 or 1 lymph node metastasis from the Sun Yat-sen University Cancer Center as the development set, and the validation set consisted of 186 gastric cancer patients from the Sixth Affiliated Hospital of Sun Yat-Sen University. A Chi-square test and a logistic regression analysis were used to compare the clinicopathological variables and lymph node metastasis. The C-index and ROC curve were computed for comparisons of the nomogram's predictive ability.

We developed and validated a nomogram to predict lymph node metastasis in gastric cancer before surgery. This nomogram can be broadly applied, even in general hospitals, and is useful for decisions regarding treatment programs for patients.

• gastric cancer
• lymph node metastasis
• nomogram
• risk

Lymph node status is crucial to determining treatment for early gastric cancer (EGC). We aim to establish a nomogram to predict the possibility of lymph node metastasis (LNM) in EGC patients.

Medical records of 952 EGC patients with curative resection, from 2002 to 2014, were retrospectively retrieved. Univariate and multivariate analysis were performed to examine risk factors associated with LNM. A nomogram for predicting LNM was established and internally validated.

Five variables significantly associated with LNM were included in our model, these are sex (Odd ratio [OR] = 1.961, 95% confidence index [CI], 1.334 to 2.883; P = 0.001), depth of tumor (OR = 2.875, 95% CI, 1.872 to 4.414; P = 0.000), tumor size (OR = 1.986, 95% CI, 1.265 to 3.118; P = 0.003), histology type (OR = 2.926, 95% CI, 1.854 to 4.617; P = 0.000) and lymphovascular invasion (OR = 4.967, 95% CI, 2.996 to 8.235; P = 0.000). The discrimination of the prediction model was 0.786.

A nomogram for predicting lymph node metastasis in patients with early gastric cancer was successfully established, which was superior to the absolute endoscopic submucosal dissection (ESD) indication in terms of the clinical performance.

• decision analysis
• endoscopic resection
• gastric cancer
• lymph node metastasis
• nomogram

• Early gastric cancer
• Endoscopic resection
• Lymph node metastasis

• Aged
• Cohort Studies
• Early Detection of Cancer
• Endoscopy/methods
• Female
• Gastrectomy/methods
• Humans
• Lymph Node Excision
• Lymphatic Metastasis
• Male
• Retrospective Studies
• Stomach Neoplasms/surgery

We investigated the results of quality control study prior to phase III trial of sentinel lymph node navigation surgery (SNNS).

Data were reviewed from 108 patients enrolled in the feasibility study of laparoscopic sentinel basin dissection (SBD) in gastric cancer. Seven steps contain tracer injection at submucosa (step 1) and at four sites (step 2) by intraoperative esophagogastroduodenoscopy (EGD), leakage of tracer (step 3), injection within 3 minutes (step 4), identification of at least one sentinel basin (SB) (step 5), evaluation of sentinel basin nodes (SBNs) by frozen biopsy (step 6), and identification of at least five SBNs at back table and frozen sections (step 7).

Failure in step 7 (n = 23) was the most common followed by step 3 (n = 15) and step 6 (n = 13). We did not find any differences of clinicopathological factors between success and failure group in steps 1~6. In step 7, body mass index (BMI) was only the significant factor. The success rate was 97.1% in patients with BMI  <  23 kg/m² and 80.3% in those with BMI ≥ 23 kg/m² (P = 0.028).

Lower BMI group showed higher success rate in step 7. Surgeons doing SNNS should be cautious when evaluating sufficient number of SBN in obese patients.

• Dual tracer
• Sentinel lymph node
• Stomach neoplasm

• basin dissection
• early gastric cancer
• outcomes
• sentinel node mapping
• sentinel node navigation surgery

• Endoscopic submucosal dissection (ESD)
• early gastrointestinal cancer
• gastric subepithelial tumors (SETs)
• gastric submucosal tumors (SMTs)
• gastrointestinal stromal tumor (GIST)
• laparoscopic and endoscopic cooperative surgery (LECS)

• Function-preserving
• Gastric cancer
• Laparoscopic
• Sentinel nodes

• Lymph nodes
• lymphatic metastasis
• neoplasm staging
• stomach neoplasms

• SENORITA
• Sentinel node navigation surgery
• early gastric cancer

• Gastric cancer
• early gastric cancer (EGC)
• guidelines
• lymph node navigation (LN navigation)
• minimally invasive surgery
• surgical oncology

• No.8p lymph nodes
• carbon nanoparticles
• lymph node mapping
• lymph node metastasis
• stomach neoplasms

• early gastric cancer
• endoscopic submucosal dissection
• lymph node metastasis
• nomogram
• signet ring cell carcinoma

• Aged
• Algorithms
• Carcinoma, Signet Ring Cell/pathology
• Carcinoma, Signet Ring Cell/surgery
• China
• Clinical Decision-Making/methods
• Endoscopic Mucosal Resection/methods
• Female
• Gastrectomy/methods
• Humans
• Japan
• Likelihood Functions
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Male
• Middle Aged
• Nomograms
• Retrospective Studies
• Risk Assessment/statistics & numerical data
• Risk Factors
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery

• Function-preserving surgery
• Gastric cancer
• Lymph node 8a
• Sentinel node
• Sentinel node basin