Professor Ryu Geun-won, head author of "Sentinel Lymph Node Biopsy for Laparoscopic Stomach-Preserving Surgery in Early Gastric Cancer Patients: A Randomized Clinical Trial," at the National Cancer Center Gastric Cancer Center.
[Asia Economy Reporter Chunhee Lee] A study conducted in Korea has announced for the first time in the world that in cases of early gastric cancer without metastasis, stomach-preserving surgery without gastrectomy is possible.
According to the National Cancer Center on the 14th, Professor Geunwon Ryu’s research team at the National Cancer Center’s Gastric Cancer Center recently published research results showing that in early gastric cancer, if sentinel lymph node biopsy is performed and metastasis is negative, stomach-preserving surgery can be applied instead of gastrectomy, and that patients’ quality of life and nutritional status improve after surgery.
The standard surgery for gastric cancer has been known as gastrectomy. Therefore, except for some cases of endoscopic resection, standard gastrectomy involving at least 60-70% gastrectomy and perigastric lymph node dissection has been performed on all early gastric cancer patients. If the tumor diameter is 3 cm or less in early gastric cancer, the probability of lymph node metastasis is about 10%, so stomach-preserving surgery is expected to be possible in the remaining 90%. However, since it is difficult to accurately determine lymph node metastasis before or during surgery, standard gastrectomy has generally been performed to prevent recurrence. This has caused problems where even if gastric cancer is detected early, patients suffer from decreased quality of life due to digestive or systemic symptoms caused by gastrectomy.
Accordingly, the research team conducted a randomized clinical trial titled ‘Laparoscopic sentinel node navigation surgery for stomach preservation in patients with early gastric cancer’ and found that stomach-preserving surgery using sentinel lymph nodes showed no difference in postoperative mortality compared to gastrectomy, while improving patients’ quality of life and nutritional status. These research results were published online in the March 2022 issue of the international journal Journal of Clinical Oncology.
The corresponding author, Professor Geunwon Ryu (Senior Researcher of Surgical Oncology, Surgical Specialist) at the National Cancer Center’s Gastric Cancer Center, led a prospective multicenter phase 3 randomized clinical trial involving 580 early gastric cancer patients with a joint research team of 16 members from seven university hospitals in Korea, resulting in this achievement.
The research team analyzed the outcomes of stomach-preserving surgery using sentinel lymph nodes, which are the first lymph nodes where metastasis occurs in early gastric cancer. During surgery, sentinel lymph node biopsy was performed using radiocolloids and dyes, and if pathology confirmed no metastasis, only the portion of early gastric cancer was resected while preserving the remaining stomach. The results were then compared with those of standard gastrectomy.
As a result, patients who underwent stomach-preserving surgery were able to maintain a diet and daily life close to that of healthy individuals, confirming improved quality of life and nutritional status. However, some patients experienced recurrence or metachronous gastric cancer in the preserved stomach after sentinel lymph node stomach-preserving surgery. In such cases, additional standard gastrectomy was performed, and survival rates equivalent to those who initially underwent standard gastrectomy were confirmed.
Professor Ryu said, “Although there had been speculation that sentinel lymph node stomach-preserving surgery might be possible, it had not been verified. This multicenter phase 3 study is significant in that it confirms the possibility of stomach-preserving surgery in early gastric cancer and provides clinical evidence for its implementation by publishing survival results.”
He added, “Laparoscopic sentinel lymph node stomach-preserving surgery can improve the quality of life of early gastric cancer patients without increasing mortality compared to standard surgery, even if recurrence or metachronous gastric cancer is found in some patients, as additional standard gastrectomy can be performed. It is important to establish the necessary conditions such as medical and insurance systems to enable this surgical method to be practically implemented in the future.”
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