Recent updates and current issues of sentinel node navigation surgery for early gastric cancer

Abstract

With the increase in the incidence of early gastric cancer (EGC), several endoscopic and laparoscopic approaches, such as endoscopic submucosal dissection and function-preserving gastrectomy, have been accepted as standard treatments. Sentinel node navigation surgery (SNNS) is an ideal surgical option for preservation of most parts of the stomach and consequent maintenance of normal gastric function to improve quality of life in patients with EGC. Although many previous studies and clinical trials have demonstrated the safety and feasibility of the sentinel node concept in gastric cancer, the clinical application of SNNS is debatable. Several issues regarding technical standardization and oncological safety need to be resolved. Recently several studies to resolve these problems are being actively performed, and SNNS might be an important surgical option in the treatment of gastric cancer in the future.

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

Figure 1

Intraoperative fluorescence imaging during sentinel node navigation surgery. For fluorescence imaging, Pinpoint™ system (NOVADAQ, Canada) was used. After injection of ICG, sentinel node and lymphatic flow are clearly visualized in three modes of Pinpoint™ system compared with routine image with naked eyes. (A) HD white light image after injection of ICG; (B) Pinpoint fluorescence mode; (C) Color segmented fluorescence mode; (D) Spy fluorescence mode. ICG, indocyanine green.