Sentinel lymph node biopsy to direct treatment in gastric cancer. A systematic review of the literature

Abstract

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Predictive factors for lymph node metastasis in patients with poorly differentiated early gastric cancer

“…Such sentinel node-based surgery (sentinel node navigation surgery) could be helpful in detecting possible LNM that requires radical surgery as well as obviating the need for radical surgery in those with a negligible risk of LNM. The sensitivity of sentinel lymph node biopsy and the incidence of skip metastasis have been reported to be anywhere between 45·5 and 100 per cent, and 0 and 11·8 per cent respectively 23 . The problems of false-negative and skip metastasis should be addressed to ensure that a combination of limited lymph node dissection and endoscopic surgery can be applied appropriately.…”

The role of sentinel lymph node detection in early gastric cancer – literature review

“…Early gastric cancer, defined as a malignant gastric lesion limited to the submucosal layer, has been traditionally treated by radical gastrectomy in association with lymph node dissection; however, the low rates of positive lymph nodes in association with the increased risk of perioperative complications enabled the surgeons to look for a less invasive method in order to treat early gastric cancer patients 15,16 . For example, it is estimated that up to 97% of cases diagnosed with early gastric cancer will not benefit from extended lymph node dissection, while the perioperative complication rates remain high 17 . In consequence, the concept of sentinel lymph node biopsy was proposed.…”

“…Therefore, some different therapeutic strategies and opinions have been developed. For example, while in Netherlands the first line therapeutic option is represented by radical gastrectomy with extended lymph node dissection, in the Eastern countries this protocol is rarely encountered 17,21 . In consequence, the Eastern scientists have widely investigated and later on introduced in the standard therapeutic protocol the sentinel lymph node biopsy protocol 22,23 .…”

What Is the Problem in Clinical Application of Sentinel Node Concept to Gastric Cancer Surgery?

“…Subgroup analyses of meta-analyses showed that the combination of dye and radioactive colloid detection substances is better for detection. (8,9) Either way, adequate training is required as is evident. (10-12)…”