Published online Jun 27, 2014. doi: 10.4240/wjgs.v6.i6.88
Revised: April 16, 2014
Accepted: June 10, 2014
Published online: June 27, 2014
The theory behind using sentinel node mapping and biopsy in gastric cancer surgery, the so-called sentinel node navigation surgery, is to limit the extent of surgical tissue dissection around the affected organ and subsequently the accompanied morbidity. However, obstacles on the clinical correspondence of sentinel node navigation surgery in everyday practice have occasionally alleviated researchers’ interest on the topic. Only recently with the widespread use of minimally invasive surgical techniques, i.e., laparoscopic gastric cancer resections, surgical community’s interest on the topic have been unavoidably reflated. Double tracer methods appear superior compared to single tracer techniques. Ongoing research is now focused on the invention of new lymph node detection methods utilizing sophisticated technology such as infrared ray endoscopy, florescence imaging and near-infrared technology. Despite its notable limitations, hematoxylin/eosin is still the mainstay staining for assessing the metastatic status of an identified lymph node. An intra-operatively verified metastatic sentinel lymph node will dictate the need for further conventional lymph node dissection. Thus, laparoscopic resection of the gastric primary tumor combined with the appropriate lymph node dissection as determined by the process of sentinel lymph node status characterization represents an option for early gastric cancer. Patients with T3 or more advanced disease should still be managed conventionally with resection plus standard lymph node dissection.
Core tip: Sentinel node navigation surgery can change the current surgical treatment of gastric cancer expanding the indications of minimally invasive surgical options such laparoscopic techniques. However, the complex lymphatic drainage of the stomach and the ubiquitous fear of skip metastasis make the selection of patients extremely important. Currently, laparoscopic resection of the tumor from the stomach with lymph node dissection navigated by sentinel lymph node identification represents an option only for early gastric cancer patients. Unfortunately, patients with T3 or more advanced disease should still be managed conventionally with resection plus lymph node dissection.