Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Non-exposed endoscopic wall-inversion surgery with one-step nucleic acid amplification for early gastrointestinal tumors: Personal experience and literature review
Francesco Crafa, Serafino Vanella, Aristide Morante, Onofrio A Catalano, Kelsey L Pomykala, Mario Baiamonte, Maria Godas, Alexandra Antunes, Joaquim Costa Pereira, Valentina Giaccaglia
Francesco Crafa, Serafino Vanella, Mario Baiamonte, Maria Godas, Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
Aristide Morante, Division of Gastorenterology and Endoscopy, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
Onofrio A Catalano, Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
Kelsey L Pomykala, Department of Nuclear Medicine, Department of Radiological Sciences, University Hospital Essen, University of Duisburg-Essen, Essen 45141, Germany
Alexandra Antunes, Joaquim Costa Pereira, Department of General Surgery, Braga Hospital, Braga 4710-243, Portugal
Valentina Giaccaglia, Department of Surgery, Medclinic City Hospital, Dubai 505004, United Arab Emirates
Author contributions: Crafa F wrote and edited the manuscript and collected the clinical data; Vanella S reviewed the discussion in the manuscript; Baiamonte M, Catalano OA, Pomykala KL, Godas M, Antunes A, Costa Pereira J, and Giaccaglia V revised the manuscript for important intellectual content and provided recommendations for the clinical diagnosis paragraph; All authors read and approved the final manuscript.
Institutional review board statement: This study was conducted according to the ethical principles of the Institution following the Declaration of Helsinki and with approval by the Institutional Review Board of the St. Giuseppe Moscati Hospital, No. 201801.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Dataset available from the corresponding author at nekroma@yahoo.it. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Serafino Vanella, MD, PhD, Doctor, Surgeon, Surgical Oncologist, Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, C/da Amoretta, Avellino 83100, Italy. nekroma@yahoo.it
Received: March 25, 2023
Peer-review started: March 25, 2023
First decision: April 21, 2023
Revised: May 11, 2023
Accepted: May 31, 2023
Article in press: May 31, 2023
Published online: June 28, 2023
BACKGROUND
Laparoscopic and endoscopic cooperative surgery is a safe, organ-sparing surgery that achieves full-thickness resection with adequate margins. Recent studies have demonstrated the safety and efficacy of these procedures. However, these techniques are limited by the exposure of the tumor and mucosa to the peritoneal cavity, which could lead to viable cancer cell seeding and the spillage of gastric juice or enteric liquids into the peritoneal cavity. Non-exposed endoscopic wall-inversion surgery (NEWS) is highly accurate in determining the resection margins to prevent intraperitoneal contamination because the tumor is inverted into the visceral lumen instead of the peritoneal cavity. Accurate intraoperative assessment of the nodal status could allow stratification of the extent of resection. One-step nucleic acid amplification (OSNA) can provide a rapid method of evaluating nodal tissue, whilst near-infrared laparoscopy together with indocyanine green can identify relevant nodal tissue intraoperatively.
AIM
To determine the safety and feasibility of NEWS in early gastric and colon cancers and of adding rapid intraoperative lymph node (LN) assessment with OSNA.
METHODS
The patient-based experiential portion of our investigations was conducted at the General and Oncological Surgery Unit of the St. Giuseppe Moscati Hospital (Avellino, Italy). Patients with early-stage gastric or colon cancer (diagnosed via endoscopy, endoscopic ultrasound, and computed tomography) were included. All lesions were treated by NEWS procedure with intraoperative OSNA assay between January 2022 and October 2022. LNs were examined intraoperatively with OSNA and postoperatively with conventional histology. We analyzed patient demographics, lesion features, histopathological diagnoses, R0 resection (negative margins) status, adverse events, and follow-up results. Data were collected prospectively and analyzed retrospectively.
RESULTS
A total of 10 patients (5 males and 5 females) with an average age of 70.4 ± 4.5 years (range: 62-78 years) were enrolled in this study. Five patients were diagnosed with gastric cancer. The remaining 5 patients were diagnosed with early-stage colon cancer. The mean tumor diameter was 23.8 ± 11.6 mm (range: 15-36 mm). The NEWS procedure was successful in all cases. The mean procedure time was 111.5 ± 10.7 min (range: 80-145 min). The OSNA assay revealed no LN metastases in any patients. Histologically complete resection (R0) was achieved in 9 patients (90.0%). There was no recurrence during the follow-up period.
CONCLUSION
NEWS combined with sentinel LN biopsy and OSNA assay is an effective and safe technique for the removal of selected early gastric and colon cancers in which it is not possible to adopt conventional endoscopic resection techniques. This procedure allows clinicians to acquire additional information on the LN status intraoperatively.
Core Tip: The treatment efficacy of non-exposed endoscopic wall-inversion surgery combined with sentinel lymph node (LN) biopsy and intraoperative one-step nucleic acid amplification assay remains to be fully evaluated in early gastric and colon cancers. The patients included in the experiential portion of our investigations were diagnosed with early gastric and colon cancers that were not amenable to conventional endoscopic resection techniques. We found that this approach provides essential details on LN status intraoperatively and we discuss the related literature to help guide future research studies and clinical care.
