Feasibility of sentinel node navigation surgery after noncurative endoscopic resection for early gastric cancer

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background and Aim</jats:title><jats:p>Recently, the use of additional surgery after noncurative endoscopic resection has gradually increased due to the rapid spread of endoscopic treatments in selected patients with early gastric cancer. Sentinel node navigation surgery (<jats:styled-content style="fixed-case">SNNS</jats:styled-content>) has also been recognized as a minimally invasive surgery with personalized lymphadenectomy in early gastric cancer. Here, we assessed the feasibility of <jats:styled-content style="fixed-case">SNNS</jats:styled-content> after noncurative endoscopic resection for early gastric cancer.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Sixteen patients with early gastric cancer, in whom additional surgery had been indicated due to noncurative endoscopic resection, were enrolled. They underwent a gastrectomy with standard lymphadenectomy. One day before surgery, <jats:sup>99m</jats:sup>technetium‐tin colloid was endoscopically injected into the submucosa around the tumor. After surgery, the uptake of radioisotope in dissected lymph nodes was measured using Navigator <jats:styled-content style="fixed-case">GPS</jats:styled-content>. Then, all dissected lymph nodes were investigated by hematoxylin‐eosin staining and immunohistochemistry using an antihuman cytokeratin monoclonal antibody.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Hematoxylin‐eosin staining demonstrated lymph node metastasis in two (12.5%) of 16 patients and in three (0.8%) of 382 nodes. However, immunohistochemistry showed that none of the patients had lymph node micrometastasis. Sentinel nodes (<jats:styled-content style="fixed-case">SN</jats:styled-content>s) were identified in all patients. The mean number of <jats:styled-content style="fixed-case">SN</jats:styled-content>s was 3.1 (range, 1–6). Among two patients with lymph node metastasis, the <jats:styled-content style="fixed-case">SN</jats:styled-content>s, at least, contained positive nodes. Accordingly, the false‐negative and accuracy rates were 0% and 100%, respectively.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Our results indicate that <jats:styled-content style="fixed-case">SNNS</jats:styled-content> may have potential as a further minimally invasive surgery in early gastric cancer patients after noncurative endoscopic resection.</jats:p></jats:sec>