Feasibility of a standardized pathological protocol for lymphatic basin evaluation during sentinel node navigation surgery in early gastric cancer: preliminary results from the FLECSS trial
Year: 2026
Type: article
Abstract: Background: During sentinel node navigation surgery (SNNS) in patients with early gastric cancer (EGC), pathologic examination of lymphatic basin specimen is crucial. In this study, we established and evaluated the feasibility and preliminary diagnostic concordance of a standardized pathologic protocol. Methods: A retrospective analysis was conducted using data from the Fluorescence guided Laparoscopic-Endoscopic Cooperative Sentinel node navigation surgery Strategy trials (FLECSS) from February 2024 and December 2025. The protocol comprised lymphatic basin specimen collection, processing, and pathological evaluation, intraoperative frozen section analysis, postoperative pathological examination, and the detection of occult metastases. The effectiveness and reliability were evaluated by examining the concordance with postoperative pathology. Results: Lymphatic basins were successfully identified in all 60 patients. Intraoperative evaluation identified 496 nodes (mean 8.3 per patient), of which 67.3% were sentinel nodes (SNs) and 32.7% were non-SNs within the basin. Four patients (6.7%) were diagnosed with lymph node metastasis (LNM) on intraoperative frozen section and were successfully converted to radical gastrectomy with D2 lymphadenectomy. Among these, one patient had additional LNM outside lymphatic basin in the D2 specimen. The protocol demonstrated concordance between intraoperative and postoperative findings in this cohort, with no metastatic involvement detected in non-SNs or occult nodes (ONs) within the basin. Conclusions: This structured pathological protocol appears feasible and showed favorable concordance between intraoperative and postoperative pathological findings in this preliminary cohort. However, its diagnostic performance and oncological reliability require further validation in larger studies with longer follow-up. The detection of micrometastasis and ONs within the basin underscores the potential value of standardized ultra-staging pathology in the pathological assessment of SNNS specimens.
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223358538