Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2020; 8(16): 3474-3482
Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3474
Combination of endoscopic submucosal dissection and laparoscopic sentinel lymph node dissection in early mucinous gastric cancer: Role of lymph node metastasis
Hua Li, Li-Li Zhao, Xiao-Chong Zhang, Deng-Xiang Liu, Gui-Ying Wang, Zhi-Bin Huo, Shu-Bo Chen
Hua Li, Li-Li Zhao, Xiao-Chong Zhang, Deng-Xiang Liu, Zhi-Bin Huo, Shu-Bo Chen, Institute of Cancer Control, Xingtai People’s Hospital, Xingtai 054001, Hebei Province, China
Gui-Ying Wang, Department of General Surgery, Fourth Affiliated Hospital of Hebei Medial University, Shijiazhuang 050000, Hebei Province, China
Author contributions: Li H, Zhao LL, Zhang XC, and Liu DX contributed equally to this work; Huo ZB, Chen SB, and Wang GY should be regarded as co-corresponding authors of this article; Huo ZB, Chen SB, and Wang GY designed the research; Li H analyzed the data and drafted the manuscript; Zhao LL and Zhang XC revised the manuscript critically for important intellectual content and contributed to the data analysis; Liu DX helped draft the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: This study is a retrospective study for the data of patients collected from the Department of Surgical Oncology, Xing Tai People’s Hospital during 1988-2016. No human body was involved in this study. According to our hospital’s policy, this study does not require an approval by the hospital institutional review board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interest is declared by the authors.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhi-Bin Huo, PhD, Professor, Institute of Cancer Control, Xingtai People’s Hospital, No. 16 Hongxing Street, Xingtai 054001, Hebei Province, China. zhibinhwcwk@126.com
Received: March 20, 2020
Peer-review started: March 20, 2020
First decision: April 29, 2020
Revised: July 5, 2020
Accepted: July 16, 2020
Article in press: July 16, 2020
Published online: August 26, 2020
Processing time: 158 Days and 0.5 Hours
Abstract
BACKGROUND

Recent evidence showed that combining endoscopic submucosal dissection (ESD) and laparoscopic sentinel lymph node dissection may avoid unnecessary gastrectomy in treating early mucinous gastric cancer (EMGC) patients with risks of positive lymph node metastasis (pLNM).

AIM

To explore the predictive factors for pLNM in EMGC, and to optimize the clinical application of combing ESD and sentinel lymph node dissection in a proper subgroup of patients with EMGC.

METHODS

Thirty-one patients with EMGC who had undergone gastrectomy with lymph node dissection were consecutively enrolled from January 1988 to December 2016. Univariate and multivariate logistic regression analyses were used to estimate the association between the rates of pLNM and clinicopathological factors, providing odds ratio (OR) with 95% confidence interval. And the association between the number of predictors and the pLNM rate was also investigated.

RESULTS

Depth of invasion (OR = 7.342, 1.127-33.256, P = 0.039), tumor diameter (OR = 9.158, 1.348-29.133, P = 0.044), and lymphatic vessel involvement (OR = 27.749, 1.821-33.143, P = 0.019) turned out to be significant and might be the independent risk factors for predicating pLNM in the multivariate analysis. For patients with 1, 2, and 3 risk factors, the pLNM rates were 9.1%, 33.3%, and 75.0%, respectively. pLNM was not detected in seven patients without any of these risk factors.

CONCLUSION

ESD might serve as a safe and sufficient treatment for intramucosal EMGC if tumor size ≤ 2 cm, and when lymphatic vessel involvement is absent by postoperative histological examination. Combining ESD and sentinel lymph node dissection could be recommended as a safe and effective treatment for EMGC patients with a potential risk of pLNM.

Keywords: Endoscopic submucosal dissection; Early gastric cancer; Mucinous gastric cancer; Laparoscopic sentinel lymph node dissection

Core tip: A combination of laparoscopic sentinel lymph node dissection (SLND) and endoscopic submucosal dissection (ESD) may avoid unnecessary surgical intervention in early mucinous gastric cancer (EMGC) patients having a potential risk of positive lymph node metastasis (pLNM). ESD allows the complete local resection of the primary tumor, and SLND enables the confirmation of lymph node status. We performed this current retrospective study to identify risk factors that are predictive factor for pLNM in EMGC and to establish a primary criterion and working flowchart to expand the possibility of using ESD and SLND for the treatment of EMGC. The combination of ESD and SLND could be recommended as an effective, minimally invasive treatment for EMGC patients with a high risk of pLNM.