Potential and futility of sentinel node detection for gastric cancer

The technique and scientific background of sentinel node dissection has spread extremely rapidly over the surgical community. Following the addition of this technique to the tools of oncologic surgery for treatment of malignant melanoma and breast cancer, questions arise regarding the use of this method in gastric cancer also. While the lymphatic flow on the surface of the body can be defined easily, the lymphatic drainage of the stomach is much more complicated. Following rotation of the stomach during embryonic development, the lymphatic flow is not directed in a simple fashion. It is questionable whether a specific area of the stomach will drain into one lymph node echelon only. This is one of the essential obstacles for SLND in gastric cancer. Furthermore, skip metastasis seems to be quite common in cancer of the stomach. In gastric cancer, the value and the extent of classical lymph node dissection itself is still under scientific discussion. The rationale, aims, and extent of LA in gastric cancer are addressed. The scientific discussion on whether D1 or an extended lymphadenectomy are appropriate is not finally closed as yet. The possibilities and problems concerning an individualised indication for a selective lymphadenectomy in gastric cancer are discussed.