Burgeoning study of sentinel-node analysis on management of early gastric cancer after endoscopic submucosal dissection

Abstract

Endoscopic submucosal dissection (ESD) represents an organ-preserving alternative to surgical resection of early gastric cancer. However, even with ESD yielding en-bloc resection specimens, there are concerns regarding tumor spread such as with larger lesions, ulcerated lesions, undifferentiated pathology and submucosal invasion. Sentinel node navigational surgery (SNNS) when combined with ESD offers a minimally invasive alternative to the traditional extended gastrectomy and lymphadenectomy if lack of lymph node spread can be confirmed. This would have a clear advantage in terms of potential complications and quality of life. However, SNNS, though useful in other malignancies such as breast cancer and melanoma, may not have a sufficient sensitivity for malignancy and negative predictive value in EGC to justify this as standard practice after ESD. The results of SNNS may improve with greater standardization and more involved dissection, technological innovations and more experience and validation such that the paradigm for post-ESD resection of EGC may change and include SNNS.

Keywords: Early gastric cancer, Sentinel node, Sentinel node navigation surgery, Expanded criteria, Endoscopic submucosal dissection, Function-preserving gastrectomy, Organ preserving surgery, Lymphadenectomy

Core tip: Sentinel node navigation surgery after endoscopic submucosal dissection represents a minimally invasive approach to gastric cancer. However, this approach is controversial because it is not standardized nor has it been well validated outside of few centers in Asia. We will discuss these controversies and the potential of sentinel node navigational surgery to become an accepted diagnostic modality for select early gastric cancer patients.