Sentinel lymph node navigation surgery for gastric cancer: Does it really benefit the patient?

Abstract

Sentinel lymph node (SLN) navigation surgery is accepted as a standard treatment procedure for malignant melanoma and breast cancer. However, the benefit of reduced lymphadenectomy based on SLN examination remains unclear in cases of gastric cancer. Here, we review previous studies to determine whether SLN navigation surgery is beneficial for gastric cancer patients. Recently, a large-scale prospective study from the Japanese Society of Sentinel Node Navigation Surgery reported that the endoscopic dual tracer method, using a dye and radioisotope for SLN biopsy, was safe and effective when applied to cases of superficial and relatively small gastric cancers. SLN mapping with SLN basin dissection was preferred for early gastric cancer since it is minimally invasive. However, previous studies reported that limited gastrectomy and lymphadenectomy may not improve the patient's postoperative quality of life (QOL). As a result, the benefit of SLN navigation surgery for gastric cancer patients, in terms of their QOL, is limited. Thus, endoscopic and laparoscopic limited gastrectomy combined with SLN navigation surgery has the potential to become the standard minimally invasive surgery in early gastric cancer.

Keywords: Endoscopic and laparoscopic treatment; Gastric cancer; Quality of life; Sentinel lymph node basin; Sentinel lymph node navigation surgery.

Figure 1

Minute sentinel lymph nodes could not be detected by indocyanine green alone (left), but could be detected by using photodynamic eye (right).

Figure 2

Mapping of lymph node micrometastases detected by MUC 2 RT-PCR in pT1 gastric cancer according to the tumour location[20]. Circular dots represent lymph node micrometastases as detected by MUC 2 RT-PCR. Ca represents the tumour location.