Abstract
Gastric cancer patients represent a rather divergent patient group and in certain carefully selected cases of early forms of gastric cancer the D2 gastrectomy could be considered a more radical procedure than the biological and oncological characteristics of the primary tumor on the gastric wall would require. As any unnecessary dissection increases morbidity without always respective survival benefits, an approach that could accurately predict and actually dictate the exact extent of lymph node dissection would be ideal. It is more than logical the assumption that the standard D2 lymphadenectomy could represent an overtreatment in distinct patients groups such as patients with early gastric cancer with favorable pathological characteristics and clinically negative nodes not suitable for endoscopic treatment because this early stage disease shows limited lymph node metastasis incidence and excellent overall survival. Considering that the D2 gastrectomy has a negative impact on the quality of life of gastric cancer patients due to the post-gastrectomy functional results, a concept of a more targeted lymph node dissection, when appropriate, is certainly appealing. It is yet to be proven whether sentinel lymph node navigation surgery can fulfill such expectations providing the appropriate balance between morbidity and oncological safety in selected gastric cancer patients.
Highlights
Gastric cancer is a rather common malignancy, the 6th most common according to the GLOBOCAN 2012 data, with a reported mortality of 8.9/100,000 population [1]
Sentinel Lymph Node Surgery recurrence rate after D2 procedure and attributed the D2 associated morbidity and mortality to the spleno-pancreatectomy that was routinely performed in the D2 patient group
Taking this concept one step further, a properly standardized sentinel lymph node navigation surgery could ideally create the conditions for a precise and limited lymph node dissection probably required in selected patient group
Summary
Techniques and Current Role of Sentinel Lymph Node (SLN) Concept in Gastric Cancer Surgery. As any unnecessary dissection increases morbidity without always respective survival benefits, an approach that could accurately predict and dictate the exact extent of lymph node dissection would be ideal. It is more than logical the assumption that the standard D2 lymphadenectomy could represent an overtreatment in distinct patients groups such as patients with early gastric cancer with favorable pathological characteristics and clinically negative nodes not suitable for endoscopic treatment because this early stage disease shows limited lymph node metastasis incidence and excellent overall survival. It is yet to be proven whether sentinel lymph node navigation surgery can fulfill such expectations providing the appropriate balance between morbidity and oncological safety in selected gastric cancer patients
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