[Progress in sentinel node navigation surgery for gastric cancer]

Sentinel lymph nodes (SLNs) are identified by injecting lymphatic tracer dye or radioisotope-labeled particles, or both, around a gastric tumor into the submucosa endoscopically or into the subserosa from the exterior of the stomach. Many reports have suggested the feasibility of the SLN concept in T1 gastric cancer. We consider it reasonable to convert from D1+alpha/beta dissection to D2 dissection when an SLN biopsy is positive and have used this strategy since 2000. Although false-negative SLN biopsy results cannot be avoided, previous studies suggested that the dissection of lymph node stations where SLNs occur (SLN stations) may minimize the possibility of leaving metastases, even micrometastases, behind in cases of a negative SLN biopsy. Since 2003, we have performed limited gastrectomy with dissection of SLN stations when the SLN biopsy was negative. A sleeve gastrectomy was sometimes needed due to the distribution of SLN stations or the location of the tumor. It is preferable to conclude the surgery with endoscopic submucosal dissection in cases of negative SLN biopsy, which is performed laparoscopically. For this final goal, it is mandatory to standardize the method of SLN identification and to increase the sensitivity of intraoperative diagnosis of lymph node metastases.