Abstract：
BACKGROUND: Sentinel node navigation (SNN) has been known as the effective treatment for stomach-preserving surgery in early gastric cancer; however, SNN presents several technical difficulties in real practice.
OBJECTIVE: This study aimed to evaluate the feasibility of regional lymphadenectomy omitting SNN, using the post hoc analysis of a randomized controlled trial.
METHODS: Using data from the SENORITA trial that compared laparoscopic standard gastrectomy with lymphadenectomy and laparoscopic SNN, 237 patients who underwent SNN were included in this study. Tumor location was divided into longitudinal and circumferential directions. According to the location of the tumor, the presence or absence of lymph node (LN) metastases between sentinel and non-sentinel basins were analyzed. Proposed regional LN stations were defined as the closest area to the primary tumor. Sensitivities, specificities, positive predictive values, and negative predictive values (NPV) of SNN and regional lymphadenectomy were compared.
RESULTS: Metastasis to non-sentinel basins with tumor-free in sentinel basins was observed in one patient (0.4%). The rate of LN metastasis to non-regional LN stations without regional LN metastasis was 2.5% (6/237). The sensitivity and NPV of SNN were found to be significantly higher than those of regional lymphadenectomy (96.8% vs. 80.6% [p = 0.016] and 99.5% vs. 97.2% [p = 0.021], respectively).
CONCLUSIONS: This study showed that regional lymphadenectomy for stomach-preserving surgery, omitting SNN, was insufficient; therefore, SNN is required in stomach-preserving surgery.
OBJECTIVE: This study aimed to evaluate the feasibility of regional lymphadenectomy omitting SNN, using the post hoc analysis of a randomized controlled trial.
METHODS: Using data from the SENORITA trial that compared laparoscopic standard gastrectomy with lymphadenectomy and laparoscopic SNN, 237 patients who underwent SNN were included in this study. Tumor location was divided into longitudinal and circumferential directions. According to the location of the tumor, the presence or absence of lymph node (LN) metastases between sentinel and non-sentinel basins were analyzed. Proposed regional LN stations were defined as the closest area to the primary tumor. Sensitivities, specificities, positive predictive values, and negative predictive values (NPV) of SNN and regional lymphadenectomy were compared.
RESULTS: Metastasis to non-sentinel basins with tumor-free in sentinel basins was observed in one patient (0.4%). The rate of LN metastasis to non-regional LN stations without regional LN metastasis was 2.5% (6/237). The sensitivity and NPV of SNN were found to be significantly higher than those of regional lymphadenectomy (96.8% vs. 80.6% [p = 0.016] and 99.5% vs. 97.2% [p = 0.021], respectively).
CONCLUSIONS: This study showed that regional lymphadenectomy for stomach-preserving surgery, omitting SNN, was insufficient; therefore, SNN is required in stomach-preserving surgery.
摘要：
背景：前哨淋巴结导航（SNN）被认为是早期胃癌保胃手术的有效治疗方法；然而，SNN在实际实践中存在几个技术困难。
目的：本研究旨在评估省略SNN的区域淋巴结清扫术的可行性，使用随机对照试验的事后分析。
方法：使用SENORITA试验的数据，比较了腹腔镜标准胃切除术与淋巴结清扫术和腹腔镜SNN，237名接受SNN的患者被纳入本研究。肿瘤位置分为纵向和周向。根据肿瘤的位置,分析了前哨和非前哨盆地之间是否存在淋巴结（LN）转移。建议的区域LN站被定义为最接近原发性肿瘤的区域。敏感度,特殊性，阳性预测值，比较了SNN和区域性淋巴结清扫术的阴性预测值（NPV）。
结果：在一名患者（0.4％）中观察到无肿瘤的非前哨盆地转移。无区域性LN转移的非区域性LN站的LN转移率为2.5％（6/237）。SNN的敏感性和NPV明显高于区域淋巴结清扫术（96.8%vs.80.6%[p=0.016]和99.5%vs.97.2%[p=0.021]，分别)。
结论：这项研究表明，局部淋巴结清扫术用于保胃手术，省略SNN，是不够的；因此，SNN在保胃手术中是必需的。
目的：本研究旨在评估省略SNN的区域淋巴结清扫术的可行性，使用随机对照试验的事后分析。
方法：使用SENORITA试验的数据，比较了腹腔镜标准胃切除术与淋巴结清扫术和腹腔镜SNN，237名接受SNN的患者被纳入本研究。肿瘤位置分为纵向和周向。根据肿瘤的位置,分析了前哨和非前哨盆地之间是否存在淋巴结（LN）转移。建议的区域LN站被定义为最接近原发性肿瘤的区域。敏感度,特殊性，阳性预测值，比较了SNN和区域性淋巴结清扫术的阴性预测值（NPV）。
结果：在一名患者（0.4％）中观察到无肿瘤的非前哨盆地转移。无区域性LN转移的非区域性LN站的LN转移率为2.5％（6/237）。SNN的敏感性和NPV明显高于区域淋巴结清扫术（96.8%vs.80.6%[p=0.016]和99.5%vs.97.2%[p=0.021]，分别)。
结论：这项研究表明，局部淋巴结清扫术用于保胃手术，省略SNN，是不够的；因此，SNN在保胃手术中是必需的。
