Current status and challenges in sentinel node navigation surgery for early gastric cancer

Abstract

Although a number of feasibility studies for sentinel node (SN) concepts in gastric cancer have been conducted since 2000, there remains a debate regarding detailed detection techniques and oncological safety. Two important multicenter phase II clinical trials were performed in Japan that used different methods and reached different conclusions; one confirmed acceptable results with a false-negative rate of 7%, and the other showed an unacceptably high false-negative rate of 46.4%. The Sentinel Node Oriented Tailored Approach (SENORITA) trial is a multicenter randomized controlled phase III trial being performed in Korea. Patient enrollment is now complete and the long-term results are currently awaited. Recently, an image-guided SN mapping technique using infrared ray/fluorescence was introduced. This method might be a promising technology because it allows the clear visualization of SNs. With regard to the primary tumor, the non-exposed endoscopic wall-inversion surgery technique and non-exposure endolaparoscopic full-thickness resection with simple suturing technique have been reported. These methods prevent abdominal infection and tumor seeding and can be good alternatives to conventional laparoscopic gastric wedge resection. For indications, SN navigation surgery can be extended to patients who underwent non-curative endoscopic resection. Although a few studies have been performed on these patients, sentinel concepts may be beneficial to patients as they omit the need for additional gastrectomy. SN navigation surgery can lead to actual organ-preserving surgery and plays a key role in improving the quality of life of patients with early gastric cancer in the future.

Keywords: SENORITA; Sentinel node navigation surgery; early gastric cancer.

1

Study flow of the Sentinel Node Oriented Tailored Approach (SENORITA) trial. SBD, sentinel basin dissection; LND, lymph node dissection; DFS, disease-free survival; RFS, recurrence-free survival; OS, overall survival.

2

Images of the endolaparoscopic full-thickness with simple suturing procedures. (A) Endoscopic circumferential incision of the mucosal layer; (B) Laparoscopic seromuscular suturing which results in inversion of the stomach wall; (C) Endoscopic full-thickness resection; (D) Endoscopic mucosal suturing by placement of endoloops and clips.