Sentinel node navigation surgery in gastric cancer

Abstract

The sentinel node (SN) concept has revolutionized surgery for both melanoma and breast cancer over the past two decades. The clinical utility of the SN concept has been confirmed, and individualized treatment based on the status of SNs is well accepted in breast cancer. However, the clinical application of SN navigation surgery (SNNS) for gastric cancer has remained highly controversial during last decade due to the complexity of lymphatic flow in the stomach. A recent meta-analysis and prospective multicenter studies have shown an acceptable rate of detection of SNs and a high accuracy in determining SN status. At present, a dual tracer method using radioactive colloid and vital dye is considered the best means to detect SNs in gastric cancer. Nonetheless, new technologies such as near infrared imaging and fluorescence imaging using indocyanine green have potential to improve the quality of SNNS and change the treatment strategy for gastric cancer. Additionally, rapid intraoperative immunohistochemical staining and intraoperative real-time reverse transcription polymerase chain reaction assay can be used to supplement traditional hematoxylin-eosin staining. In the near future, minimally invasive, function-preserving procedures based on SN mapping of the stomach will likely become increasingly utilized. Herein, the current status of SNNS and individualized treatments for gastric cancer are reviewed. Keywords: Sentinel lymph node biopsy, Sentinel node, Sentinel node navigation surgery, Gastric cancer