Quality of life after laparoscopic limited gastrectomy using sentinel node navigation technique in gastric cancer: single arm and single center, phase II clinical trial (NCT01441310)

Hyung-Ho Kim1, Sang-Yong Son1, Ju-Hee Lee2, Sang-Hoon Ahn1, Do Joong Park1, Do Hyun Jung1, Cheol Min Shin3, Young Soo Park3, Hye Seung Lee4. 1Department of Surgery, Seoul National University Bundang Hospital, 2Department of Surgery, Hanyang University Bundang Hospital, 3Department of Internal Medicine, Seoul National University Bundang Hospital, 4Department of Pathology, Seoul National University Bundang Hospital

Background: The aim of this study was to evaluate the functional outcomes and quality of life after laparoscopic limited gastrectomy using sentinel node navigation technique (SNNS) in cT1N0M0 and cT2N0M0 gastric cancer patients.

Methods: From July 2010 to April 2013, patients who underwent laparoscopic SNNS at Seoul National University Bundang Hospital were enrolled prospectively. The perioperative parameters, complications, and tumor recurrence were evaluated. Gastric emptying time, quality of life (QOL) and nutritional status were compared with those of conventional laparoscopic distal gastrectomy (LDG).

Results: Of the 100 enrolled patients, 11 patients had positive sentinel node. The sentinel basin detection rate was 100% and sentinel node (SN) detection rate was 99%. The mean number of SN was 6.07±3.84 (range: 0-17) and the mean number of non-sentinel node (NSN) was 4.60 (range: 0-25). Among 89 SN negative patients, three patients had false negative SN (3.37%) on final histology. The mean operation time was 199.9 minutes and the mean hospital stay was 5.2 days. There was no mortality except 4 complications (4.5%). The mean gastric emptying time was significantly shorter than that of conventional laparoscopic distal gastrectomy (263 min vs. 579 min, p=0.039). The mean changes of QOL scores from preoperative baseline was significantly better in SNNS than conventional LDG in terms of global health status, physical functioning, emotional functioning, cognitive function, social function, fatigue, appetite loss, diarrhea, insomnia, dysphagia, eating restriction, anxiety, and body image. Regarding nutritional status, body weight losses after were 2.2% in SNNS and 6.3% in LDG at 2 years after discharge, respectively (p=0.03). Decreases of abdominal fat area were significantly greater in LDG than in SNNS (visceral fat area: 46.7% vs. 4.9%, p<0.001; subcutaneous fat area: 15.4% vs. 9.5% increase, p<0.001). The biochemical data including hemoglobin, total lymphocyte count, total cholesterol, serum albumin, and serum transferrin showed no significant difference between two groups, but serum protein showed significant changes between two groups (postoperative 1 year: -0.01 in SNNS vs. -0.25 in LDG, p=0.001; postoperative 2 years: -0.06 in SNNS vs. -0.15 in LDG, p=0.02)

Conclusion: SNNS was not only feasible technically but also safe oncologically and better functionally.

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