Novel surgical approach based on the sentinel node concept in patients with early gastric cancer

Abstract

Recent prospective multicenter trials have demonstrated the clinical safety and efficacy of sentinel node navigation surgery (SNNS) in patients with early gastric cancer. Further, development of an intraoperative imaging system and an indocyanine green fluorescence imaging approach has been attracting attention as a novel tool for detection of the sentinel node (SN). The greatest advantage of an in vivo imaging system is that it visualizes SN and afferent lymphatic vessels from the primary tumor site more clearly than the conventional dye approach. Besides visualization of the SN, it is also essential to accurately assess the presence or absence of lymph node metastasis in the intraoperative management of SNNS. However, the clinical significance of lymph node micrometastasis (LNM) in patients with gastric cancer remains controversial. Reverse transcription‐polymerase chain reaction (RT‐PCR) is one of the representative assays used to identify LNM. A rapid RT‐PCR assay that completes the detection of LNM within approximately 40 minutes has recently been produced and applied in the clinical management of SNNS. From the viewpoint of surgical methods, modified laparoscopic and endoscopic cooperative surgery with non‐exposed approaches has recently been highlighted as a promising technique to prevent tumor dissemination caused by surgical procedures, and is likely to be clinically applied to SNNS in the future. When carrying out SNNS as a minimally invasive surgery, it is important to consider the balance between post‐surgical quality of life and curability. Future prospective studies on SNNS will greatly contribute to furthering its establishment as a beneficial procedure for patients with early gastric cancer.

Combination of endoscopic submucosal dissection and laparoscopic sentinel lymph node dissection in early mucinous gastric cancer: Role of lymph node metastasis

“…Our results suggested that several clinicopathologic features accounted for the presence of pLNM: Submucosal invasion, tumor diameter > 2 cm, and positive LVI. These results focusing on EMGC are in line with some previous researchers’ reports, indicating a significant association of large tumor, positive LVI, and submucosal invasion with high pLNM risk[ 12 , 13 , 17 - 19 ].…”

“…Combining ESD and SLND might avoid unnecessary gastrectomy in EMGC patients. ESD could ensure en bloc resection of the primary tumor while SLND could confirm the lymph node metastatic status[ 19 , 20 ]. A sentinel node is defined as the lymph node that directly receives lymphatic drainage from the primary tumor[ 21 ].…”

Evaluation of postoperative quality of life by PGSAS-45 following local gastrectomy based on the sentinel lymph node concept in early gastric cancer

“…This surgical method has the clinical utility of a nonexposed approach as well as NEWS. In CLEAN-NET, the seromuscular layer is dissected from outside the stomach using a spatula-shaped electrocautery knife under laparoscopy and a full-thickness specimen including the tumor is dissected using a laparoscopic stapling device to prevent the risk of tumor dissemination caused by opening of the stomach [22]. We have performed CLEAN-NET with SN basin dissection on selected patients with cT1 and cN0 gastric cancer measuring < 4.0 cm in diameter [23].…”

Mapping Lymph Node during Indocyanine Green Fluorescence-Imaging Guided Gastric Oncologic Surgery: Current Applications and Future Directions

“…Hence, the concept of SLNs is vital for the establishment of LN status in patients with early-stage cancer [ 21 , 22 , 23 ]. As ICG-FI was found effective in tattooing lymph systems, it emerged as a novel technique for SLNs detection in gastric cancer [ 24 ]. SLNs detection by utilizing ICG-FI received diagnostic accuracy 97.3% in T1 and 95.0% in T2 [ 25 ].…”