National Cancer Center , World’s First Stomach-Preserving Non-Gastrectomy Surgery for Early Gastric Cancer Patients

Dr. Ryu Keun-won at the National Cancer Center examined the effectiveness of stomach-preserving surgery based on a comparison of sentinel lymph node stomach-preserving surgery and standard gastrectomy. 

A research team led by Professor Ryu Keun-won at the Gastric Cancer Center of the National Cancer Center became the world’s first to report that for early gastric cancer patients who test negative for metastasis on a sentinel lymph node biopsy, stomach-preserving surgery can be performed, which generally results in a better quality of life and nutritional status after surgery compared to gastrectomy. 

Currently, the standard surgery for gastric cancer is gastrectomy. Even when it comes to treating early gastric cancer, standard gastrectomy involving removal of at least 60 to 70 % of the stomach along with paragastric lymphadenectomy is performed for all patients, other than instances in which endoscopic resection is carried out. 

In the case of early gastric cancer where the tumor is no bigger than 3 cm in diameter, the probability of lymph node metastasis is around 10 %, and stomach-preserving surgery is deemed possible if it has not metastasized as such. However, standard gastrectomy is generally performed to prevent recurrence because it’s not possible to know with 100% accuracy whether lymph node metastasis has occurred before or even during surgery. This is why gastrectomy is performed even on patients who are diagnosed with early gastric cancer, and their quality of life typically deteriorates after surgery due to digestive or systemic issues. 

From their study, Dr. Ryu’s research team learned that stomach-preserving surgery using sentinel lymph nodes showed no difference in post-operative mortality and actually improved the quality of life and nutritional status of patients after surgery when compared with gastrectomy. Their paper, Laparoscopic Sentinel Node Navigation Surgery for Stomach Preservation in Patients with Early Gastric Cancer: A Randomized Clinical Trial, was published online in the March 2022 issue of the Journal of Clinical Oncology, a prestigious international scientific journal.

The paper was based on a prospective, multicenter, Phase 3 randomized clinical trial with 580 early gastric cancer patients, conducted by lead author Dr. Ryu Geun-won, professor and surgeon at the Gastric Cancer Center at the National Cancer Center (senior researcher at the Department of Surgical Oncology Research), along with 16 researchers from 7 university hospitals in Korea. 

In this study, the research team analyzed the results of the stomach-preserving operation carried out using sentinel lymph nodes, which are where metastasis first occurs in early gastric cancer. During surgery, a sentinel lymph node biopsy was performed using radioactive isotopes and pigments, and if the test came back negative, only the early gastric cancer portion was resected and the rest of the stomach was preserved. The results were compared with those of standard gastrectomy for analysis. 

Following laparoscopic sentinel node navigation surgery for stomach preservation, metachronous gastric cancer in the relapsed or preserved stomach in some patients. However, in these cases, standard gastrectomy could be performed additionally, with the survival rate remaining equal to cases in which standard gastrectomy was performed first. It was also found that patients who underwent stomach-preserving surgery were able to enjoy a better quality of life and nutritional status, as they were able to eat and live almost like healthy individuals. 

“There had been speculation that laparoscopic sentinel node navigation surgery for stomach preservation would be possible, but it could not be verified,” said Professor Ryu before adding, “The results on the survival rate reported by our multicenter Phase 3 clinical trial are significant in that they have confirmed the potential of stomach-preserving surgery for early gastric cancer and provided a basis for performing the operation in clinical practice.” 

Professor Ryu continued: “When it comes to laparoscopic sentinel node navigation surgery for stomach preservation, even if relapsed or metachronous gastric cancer is found in some of the patients, additional standard gastrectomy will not cause any difference in mortality rate compared to standard surgery, and [the stomach-preserving surgery] can also improve the quality of life of patients with early gastric cancer. It is crucial that various conditions, such as insurance coverage, for this surgical method to be applied in practice in the future are prepared together with the medical community.” 

The Journal of Clinical Oncology, which published the results of this study, is an official journal of the American Society of Clinical Oncology (ASCO) and it is globally renowned, with an impact factor of 44.54.

<Definitions of Terms>

* Sentinel lymph node: A lymph node where metastasis occurs first in primary gastric cancer

* Stomach-preserving surgery: A surgical procedure where only a portion of the stomach affected by early gastric cancer is removed and the rest of the stomach is left intact

* Standard gastrectomy: A surgical procedure whereby 60 to 70% of the stomach is removed along with paragastric lymphadenectomy (removal of lymph nodes around the stomach) in early gastric cancer patients 

* Metachronous gastric cancer: Gastric cancer occurring in the preserved stomach after stomach-preserving surgery