Jeong Sang-Ho, Min Jae-Seok, Kim Young-Woo, Yoon Hong Man, An Ji Yeong, Eom Bang Wool, Hur Hoon, Lee Young Joon, Cho Gyu Seok, Park Young-Kyu, Jung Mi Ran, Park Ji-Ho, Hyung Woo Jin, Kook Myeong-Cherl, Han Mira, Nam Byung-Ho, Ryu Keun Won
Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea.
Division of Foregut Surgery, Korea University Anam Hospital, Seoul, and Department of Surgery, Korea University College of Medicine, Seoul, Korea.
Ann Surg Oncol. 2025 Jun;32(6):4280-4291. doi: 10.1245/s10434-025-17114-1. Epub 2025 Mar 21.
The SENORITA phase III trial demonstrated the effectiveness of laparoscopic sentinel node navigation surgery (LSNNS) in preserving stomach function for patients with early gastric cancer (EGC), although some patients experienced surgical failure or recurrence. The purpose of this study was to analyze patients' clinicopathologic features from the SENORITA trial who were allocated to LSNNS with stomach-preserving surgery but ultimately did not preserve stomach or experienced recurrence.
Patients were categorized into two groups: the failure group (stomach preservation failure or cancer recurrence after LSNNS) and the success group (stomach preservation without recurrence following LSNNS). This study analyzed the detailed clinicopathologic characteristics of patients in the failure group from the SENORITA trial.
Among 258 patients who underwent LSNNS, 193 patients (74.8%) achieved stomach preservation, while 65 patients (25.2%) failed to preserve. Intraoperative failure was the most common cause of unsuccessful stomach preservation, occurring in 35 of 65 cases (53.8%). Advanced pathological TNM stage was the only independent risk factor by multivariate analysis, with stage IB and IIA patients showing 5.9- and 45.0-fold higher failure risks. The main causes of failure included sentinel basin detection failure, metastatic lymph nodes, positive tumors at resection margins, and complications. The failure group also included five cases of gastric cancer recurrence following LSNNS.
Accurate preoperative staging and patient selection are crucial for optimizing LSNNS outcomes. Ensuring precise resection with an adequate number of harvested sentinel basin nodes is essential to succeed the stomach-preserving surgery.
SENORITA III期试验证明了腹腔镜前哨淋巴结导航手术（LSNNS）对早期胃癌（EGC）患者胃功能保留的有效性，尽管一些患者经历了手术失败或复发。本研究的目的是分析SENORITA试验中分配接受LSNNS保胃手术但最终未保留胃或出现复发的患者的临床病理特征。
患者分为两组：失败组（LSNNS后胃保留失败或癌症复发）和成功组（LSNNS后胃保留且无复发）。本研究分析了SENORITA试验中失败组患者的详细临床病理特征。
在258例行LSNNS的患者中，193例（74.8%）实现了胃保留，而65例（25.2%）未能保留。术中失败是胃保留未成功的最常见原因，65例中有35例（53.8%）出现术中失败。多因素分析显示，高级别病理TNM分期是唯一的独立危险因素，IB期和IIA期患者的失败风险分别高出5.9倍和45.0倍。失败的主要原因包括前哨淋巴结区域检测失败、转移性淋巴结、切缘肿瘤阳性和并发症。失败组还包括5例LSNNS后胃癌复发的病例。
准确的术前分期和患者选择对于优化LSNNS结果至关重要。确保精确切除并获取足够数量的前哨淋巴结区域淋巴结是保胃手术成功的关键。
