Clin Endosc.  2016 May;49(3):298-302. 10.5946/ce.2015.114.

Hybrid Natural Orifice Transluminal Endoscopic Surgery with Sentinel Lymph Node Navigation for Deep Early Gastric Cancer in the Fundic Region

• Park YS
• Kim SH
• Ryu HY
• Cho YK
• Jo YJ
• Son TI
• Hong YO

• KMID: 2165026
• DOI: http://doi.org/10.5946/ce.2015.114

Abstract

For patients refusing surgical treatment for deep early gastric cancer, hybrid natural orifice transluminal endoscopic surgery with sentinel lymph node navigation is a potential treatment option, particularly when the anatomic location of the cancer has low probability of lymph node metastasis. We report a case of deep early gastric cancer of the fundus beyond the endoscopic submucosal dissection indication that was treated by hybrid natural orifice transluminal endoscopic surgery with sentinel lymph node navigation. In a conventional approach, a total gastrectomy would have been needed; however, the patient refused surgical intervention. In this case, since the patient showed no positivity of the sentinel lymph node on intraoperative navigation, laparoscopic basin lymph node dissection was not performed. Hybrid natural orifice transluminal endoscopic surgery might be considered for specific regions such as the safety zone where lymph node metastases are less likely to occur.

Keyword

Natural orifice endoscopic surgery; Stomach neoplasms; Lymphatic metastasis

MeSH Terms

Gastrectomy
Humans
Lymph Node Excision
Lymph Nodes*
Lymphatic Metastasis
Natural Orifice Endoscopic Surgery*
Neoplasm Metastasis
Stomach Neoplasms*

Figure

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  Fig. 1. (A, B) Transverse and coronal views of abdominal computed tomography scan showing mildly enhanced wall thickening (arrows) in the fundic area without perigastric lymphadenopathy.

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  Fig. 2. (A) White light endoscopy showing an early gastric cancer IIa lesion (arrow) with central ulceration at the fundic area. (B) Endoscopic ultrasonography revealed invasion (arrow) to the deeper submucosal layer.

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  Fig. 3. (A) Perilesional indocyanogreen injections were performed intraoperatively. (B-D) Endoscopic full-thickness resection was performed by insulated knife. (E) Laparoscopic closure was performed by stapler.

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  Fig. 4. (A) Laparoscopic view showing negativity of the sentinel lymph node after indocyanine green injection. (B) Resected full-thickness specimen revealed an adequate safety margin with all perilesional marking dots.

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  Fig. 5. Multiple well-formed tumor glands are noted in the mucosa and submucosa with abundant mucin pools (A, H&E stain, ×100; B, H&E stain, ×200).

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