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Function-Preserving Gastrectomy with Sentinel Node Navigation versus Standard Gastrectomy for Early Gastric Cancer: A Systematic Review and Meta-analysis

This systematic review and meta-analysis of 1,193 patients across six studies concludes that while function-preserving gastrectomy with sentinel node navigation offers comparable 5-year overall survival to standard gastrectomy for early gastric cancer, it does not demonstrate a significant improvement in postoperative quality of life, highlighting the need for further randomized trials to validate surgical de-escalation strategies.

Original authors: Lorenna Lim Andrade, Judith Mura, Pedro Fernandes Kalume, Eduardo Morales, Vinicius Vicuña

Published 2026-06-29✓ Author reviewed ⓘ

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CC BY 4.0

Original authors: Lorenna Lim Andrade, Judith Mura, Pedro Fernandes Kalume, Eduardo Morales, Vinicius Vicuña

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine your stomach is a busy, complex city. When a small, early troublemaker (an early-stage cancer) appears in one neighborhood, the traditional way to handle it has been to tear down the whole neighborhood and build a massive security wall around the entire city. This "Standard Gastrectomy" ensures the troublemaker is gone, but it leaves the city smaller, less functional, and the residents (the patient) often feel the loss of their normal life—trouble eating, losing weight, and feeling generally unwell.

Recently, surgeons have been trying a new strategy: Function-Preserving Gastrectomy with Sentinel Node Navigation (SNNS). Think of this as sending out a highly trained "scout" (the sentinel node) to check if the trouble has spread to the surrounding suburbs. If the scout says, "No, it's contained here," the surgeons only remove the specific block where the trouble started, leaving the rest of the city intact. The goal is to save the city's function while still keeping it safe.

This paper is a systematic review and meta-analysis, which is like a "super-review." Instead of looking at just one city, the authors gathered data from six different studies (involving 1,193 patients) to see if this new "scout" strategy actually works better than the old "tear it all down" method.

Here is what they found, broken down simply:

1. The Safety Check (Survival)

The Question: Does the new "scout" method kill the cancer just as well as the old "tear it all down" method?
The Result: Yes, they are equal.
The study found that patients who had the new, smaller surgery lived just as long as those who had the big, traditional surgery. There was no difference in the 5-year survival rates. It's like saying both strategies successfully stopped the fire; neither let it spread to the rest of the house.

2. The Recurrence Check (Did the cancer come back?)

The Question: Did the cancer sneak back in later?
The Result: No clear difference.
The rates of the cancer coming back (either in the same spot or elsewhere) were statistically the same for both groups. However, the authors warn that the number of cancer recurrences was very low in these studies, so it's hard to be 100% certain, but there is no evidence that the new method is worse.

3. The Quality of Life Check (How did the patients feel?)

The Question: This is the big one. Since the new surgery saves more of the stomach, do patients feel better? Do they eat better? Do they have less pain?
The Result: Surprisingly, no.
This was the most unexpected finding. You might think that saving more of the stomach would make people feel much better, like keeping the lights on in a house instead of turning them all off. But the data showed that patients who had the "scout" surgery felt no better than those who had the big surgery. Their pain levels, nutritional status, and general happiness were about the same.

Why might this be?

The authors suggest a few reasons for this "no difference" in quality of life:

The "Scout" isn't perfect yet: Sometimes, the navigation system (using dyes or lights to find the sentinel node) might miss a few hidden trouble spots, requiring the surgeon to do a bit more work anyway, or the anxiety of the new technique might offset the physical benefits.
The "City" is still changed: Even a smaller surgery is still a major operation on a vital organ. The body still has to heal from a significant event, regardless of how much was removed.

The Bottom Line

The paper concludes that the new "scout" method is safe (it doesn't hurt survival chances), but it hasn't yet proven to be better for how patients feel day-to-day.

The authors compare this to a new, high-tech tool that hasn't quite lived up to its promise of making life easier yet. They say we need more high-quality, randomized trials (like a perfectly controlled experiment) to figure out exactly which patients might actually benefit from this smaller surgery. For now, the "tear it all down" method remains the standard because we know it works, and the new method hasn't shown a clear advantage in making patients feel better.

In short: The new surgery is a safe alternative that saves the stomach, but it hasn't yet proven to be the "magic cure" for a better quality of life that everyone hoped it would be.

Technical Summary: Function-Preserving Gastrectomy with Sentinel Node Navigation versus Standard Gastrectomy for Early Gastric Cancer

Problem Statement
Early gastric cancer (EGC), defined as adenocarcinoma confined to the mucosa or submucosa (T1), is typically managed with endoscopic submucosal dissection (ESD) when criteria are met. However, tumors exceeding ESD indications require surgical resection. The current standard, standard gastrectomy (SG) with extensive lymphadenectomy, often compromises gastric function, leading to postoperative sequelae such as reduced food intake, weight loss, and dumping syndrome. While approximately 15%–20% of EGC patients have lymph node metastasis, many without nodal involvement undergo radical surgery unnecessarily. Function-preserving gastrectomy (FPG) guided by sentinel node navigation surgery (SNNS) was developed to reduce surgical invasiveness and preserve gastric function while maintaining oncological safety. However, the impact of SNNS on postoperative quality of life (QoL) and its long-term oncological equivalence to SG remain unclear. This study addresses the need to systematically compare oncological outcomes (specifically 5-year overall survival) and QoL metrics between FPG with SNNS and SG.

Methodology
This systematic review and meta-analysis adhered to the Cochrane Collaboration Handbook and PRISMA guidelines.

Search Strategy: A systematic search of PubMed, Embase, and the Cochrane Library was conducted up to December 2025.
Eligibility Criteria: Included studies compared FPG with SNNS against SG in patients with biopsy-proven gastric adenocarcinoma (clinical stage T1N0M0 or T2N0M0) who were not candidates for ESD. Studies required a control group, absence of distant metastasis, and reporting of clinical outcomes.
Data Extraction: Six studies comprising 1,193 patients were included (one randomized controlled trial [RCT] and five non-randomized cohort studies). The FPG/SNNS group included 552 patients (48.5%), and the SG group included 614 patients (51.5%).
Outcomes: The primary outcome was 5-year overall survival (OS). Secondary outcomes included recurrence (systemic/local), metachronous gastric cancer, and QoL metrics (gastrointestinal symptoms, global QoL, nutritional impact, and pain) assessed via validated scales (PGSAS-45, EORTC QLQ-C30, EORTC QLQ-STO22).
Statistical Analysis: A random-effects model was used for pooled analyses. Hazard ratios (HR) were calculated for OS, odds ratios (OR) for recurrence, and standardized mean differences (SMD) for continuous QoL variables. Heterogeneity was assessed using the $I^2$ statistic. Sensitivity analyses (leave-one-out) were performed to test robustness.

Key Contributions and Results

Oncological Safety: The meta-analysis found no significant difference in 5-year overall survival between the FPG/SNNS group and the SG group (HR 0.74; 95% CI 0.20–2.73; p=0.42; $I^2$ =38%).
Recurrence and Metachronous Cancer: No statistically significant differences were observed in recurrence rates (OR 2.33; 95% CI 0.00–5951.48; p=0.40) or metachronous gastric cancer (OR 2.51; 95% CI 0.00–703,499.08; p=0.52). However, the authors note these findings must be interpreted cautiously due to low event numbers and wide confidence intervals.
Quality of Life: Contrary to the hypothesis that less invasive surgery improves postoperative status, no significant differences were found in QoL outcomes, including gastrointestinal symptoms, global QoL, nutritional impact, or pain scores between the two groups.
Patient Characteristics: The pathological tumor size was significantly larger in the FPG/SNNS group compared to the SG group (MD −10.49 mm; p=0.02).
Risk of Bias: The included RCT was assessed as having a low risk of bias. Non-randomized studies generally presented a moderate risk of bias, with one study showing a serious risk due to participant selection bias.

Significance and Claims
The paper claims that function-preserving gastrectomy with sentinel node navigation surgery demonstrates comparable 5-year overall survival to standard gastrectomy in selected patients with early gastric cancer. This suggests that surgical de-escalation may be oncologically safe for specific patient populations.

However, the authors explicitly state that the study did not identify a significant improvement in postoperative quality of life for patients undergoing FPG with SNNS compared to standard gastrectomy. Consequently, the clinical benefit of these strategies remains uncertain in the absence of clear QoL advantages. The authors conclude that while these approaches represent an important step toward surgical innovation, further well-designed randomized controlled trials are required to clarify the true clinical benefit and to identify specific patient subgroups who may derive functional or symptomatic benefits from less invasive surgery without compromising oncological safety. The paper refrains from recommending widespread adoption, emphasizing the need for additional high-quality prospective data.