Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2023; 29(24): 3883-3898
Published online Jun 28, 2023. doi: 10.3748/wjg.v29.i24.3883
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
ARTICLE HIGHLIGHTS
Research background

There are more and more studies in the literature concerning endoscopic and surgical resections for organ preservation in early gastrointestinal neoplasms, respecting oncological principles. Lymph node (LN) study with one-step nucleic acid amplification (OSNA) is also the subject of numerous studies.

Research motivation

Organ-sparing endoscopic and imaging techniques do not currently allow for an accurate LN study. Using LN biopsy with rapid intraoperative results during the laparoscopic and endoscopic cooperative approach can add important information.

Research objectives

This article aims to stimulate studies that can add further information on LN status in patients with early gastrointestinal cancer, which, if treated only with endoscopic technique or with modified Laparoscopic and endoscopic cooperative surgery, would have no additional information on LN status beyond radiological ones. However, our study is the first to evaluate the utility of intraoperative OSNA assay in assessing SN in patients with early-stage gastrointestinal cancer undergoing the Non-exposed endoscopic wall-inversion surgery (NEWS).

Research methods

This pilot study with a literature review is based on data collected prospectively from a database of patients undergoing elective NEWS for early gastrointestinal cancer at St. Giuseppe Moscati Hospital of Avellino, Italy. The database included preoperative, operative, and postoperative data. Inclusion criteria included adult patients with early gastric and colonic cancer eligible for the NEWS procedure. Exclusion criteria included participants with an allergy to any indocyanine green (ICG).

Research results

A total of 10 patients were enrolled in this study, which included 5 gastric and 5 colonic early-stage cancers. The NEWS procedure was successful in all cases. The OSNA assay revealed no LN metastasis in all patients. The diagnostic accuracy in predicting the LN status based on the SN concept by OSNA compared with the postoperative histological examination was 100%. Histologically complete resection (R0) was achieved in 9 (90.0%) patients. There was no recurrence during the follow-up. An intrabdominal fluid collection treated conservatively was observed in 1 (10.0%) patient of the gastric group. One patient who underwent the removal of a lesion affecting the proximal transverse colon presented positive focal margins on a definitive histological examination. Therefore he subsequently underwent a right hemicolectomy. The definitive histological examination showed no residual tumour foci or LN metastases.The mean follow-up was 6.3 ± 4.2 mo. There was no recurrence during the follow-up period. Ours is a single-centre pilot study. The number of patients collected is small. The selected patients were all patients without LN metastasis; therefore, it is not possible to validate the sentinel node technique.

Research conclusions

Our study is the first to analyze the utility of intraoperative OSNA assay in sentinel node and nodal basin assessment in patients with early-stage gastrointestinal cancer undergoing the NEWS procedure. NEWS is a feasible and safe technique for organ-sparing surgery in selected patients. Additionally, implementing the NEWS association with the intraoperative study with OSNA will allow for more precise staging.

Research perspectives

OSNA and ICG near-infrared lymphangiography could be used to develop customized surgery and lymphadenectomy in patients with early cancers. Prospective multicenter studies with large populations of patient cohorts are needed to provide definitive conclusions.