Endoscopic Guided da Vinci Robotic Gastric Surgery for Early Gastric Cancer

Background: Endoscopic resection has been an optimal treatment for selected patients with early gastric cancer(EGC). This study aims to evaluate the result of endoscopy guided da Vinci Robotic full-thickness gastric resection(ERFTGR) with sentinel lymph node basin dissection(SLND) under indocyanine green and infrared in cases of EGC with high risk of lymph node metastasis. Method: This was a prospective, pilot study at single institute. Of 70 patients with EGC, 12 met the following criteria: 1)differentiated mucosal/submucosal cancer with an ulcer, 3-4 cm by endoscopic imaging; 2)undifferentiated mucosal/submucosal cancer without an ulcer, 2-3 cm by endoscopic imaging; 3)patients who had undergone previous ESD whose pathological reports recommended an additional gastrectomy due to a risk for LNM. Results: All cases were resected en bloc with negative surgical margins, and conducted without perioperative adverse events. . Preoperative biopsy results revealed that 7 cases were undifferentiated adenocarcinoma. Three of the 10 cases were suspected submucosal cancer by endoscopic and EUS findings. The other 2 cases that had undergone previous ESD whose pathologic result showed positive vertical margin. At the SLND, 2 patients showed LNM and underwent conventional gastrectomy. Conclusion: ERFTGR with SLND could be a bridge between ESD and conventional gastrectomy with respect to prevent extensive gastrectomy in patients with EGC.