Function-Preserving Gastrectomy for Early Gastric Cancer

Abstract

Recently, minimally invasive (endoscopic or laparoscopic) treatment for early gastric cancer (EGC) has been widely accepted. However, a standard gastrectomy with radical lymphadenectomy is generally performed in patients with EGC who have no indications for endoscopic resection, and postgastrectomy dysfunction is one of the problems of standard gastrectomy. Function-preserving gastrectomy, such as proximal gastrectomy and pylorus-preserving gastrectomy, can be considered when attempting to preserve the patient's quality of life (QOL) postoperatively. In addition, sentinel node navigation surgery for EGC has been applied in clinical practice in several prospective studies on function-preserving personalized minimized gastrectomy. In the near future, the sentinel lymph node concept is expected to form the basis for establishing an ideal, personalized, minimally invasive function-preserving treatment for patients with EGC, which will improve their postoperative QOL without compromising their long-term survival. In this review article, we summarize the current status, surgical techniques, and postoperative outcomes of function-preserving gastrectomy for EGC.

Keywords: function-preserving; gastric cancer; sentinel node.

Figure 1

Intraoperative findings of SN mapping. (a) Sentinel lymphatic staining with ICG under ordinary laparoscopy; (b) ICG fluorescence image of the same area as in (a) using VISERA ELITE II system (Olympus, Japan); (c) Sentinel lymphatic staining with ICG under ordinary laparoscopy in another case; (d) ICG fluorescence image of the same area as in (c) using FireFly of da Vince Surgical System (Intuitive, USA). SN, sentinel node; ICG, indocyanine green.