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Non-exposure Simple Suturing Endoscopic Full-thickness Resection with Sentinel Basin Dissection in Patients with Early Gastric Cancer: the SENORITA 3 Pilot Study

Journal of Gastric Cancer 2020년 20권 3호 p.245 ~ 255
엄방울, 김찬규, 국명철, 윤홍만, 류근원, 김영우, 노지윤, 김영일, 이종열, 최일주,
소속 상세정보
엄방울 ( Eom Bang-Wool ) - National Cancer Center Center for Gastric Cancer
김찬규 ( Kim Chan-Gyoo ) - National Cancer Center Center for Gastric Cancer
국명철 ( Kook Myeong-Cherl ) - National Cancer Center Center for Gastric Cancer
윤홍만 ( Yoon Hong-Man ) - National Cancer Center Center for Gastric Cancer
류근원 ( Ryu Keun-Won ) - National Cancer Center Center for Gastric Cancer
김영우 ( Kim Young-Woo ) - National Cancer Center Center for Gastric Cancer
노지윤 ( Rho Ji-Yoon ) - National Cancer Center Center for Gastric Cancer
김영일 ( Kim Young-Il ) - National Cancer Center Center for Gastric Cancer
이종열 ( Lee Jong-Yeul ) - National Cancer Center Center for Gastric Cancer
최일주 ( Choi Il-Ju ) - National Cancer Center Center for Gastric Cancer

Abstract


Purpose: Recently, non-exposure simple suturing endoscopic full-thickness resection (NESS-EFTR) was developed to prevent tumor exposure to the peritoneal cavity. This study aimed to evaluate the feasibility of NESS-EFTR with sentinel basin dissection for early gastric cancer (EGC).

Materials and Methods: This was the prospective SENORITA 3 pilot. From July 2017 to January 2018, 20 patients with EGC smaller than 3 cm without an absolute indication for endoscopic submucosal dissection were enrolled. The sentinel basin was detected using Tc99m-phytate and indocyanine green, and the NESS-EFTR procedure was performed when all sentinel basin nodes were tumor-free on frozen pathologic examination. We evaluated the complete resection and intraoperative perforation rates as well as the incidence of postoperative complications.

Results: Among the 20 enrolled patients, one dropped out due to large tumor size, while another underwent conventional laparoscopic gastrectomy due to metastatic sentinel lymph nodes. All NESS-EFTR procedures were performed in 17 of the 18 other patients (94.4%) without conversion, and the complete resection rate was 83.3% (15/18). The intraoperative perforation rate was 27.8% (5/18), and endoscopic clipping or laparoscopic suturing or stapling was performed at the perforation site. There was one case of postoperative complications treated with endoscopic clipping; the others were discharged without any event.

Conclusions: NESS-EFTR with sentinel basin dissection is a technically challenging procedure that obtains safe margins, prevents intraoperative perforation, and may be a treatment option for EGC after additional experience.

키워드

Stomach neoplasms; Endoscopy, gastrointestinal; Minimally invasive surgical procedures

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