NOTES: The question for minimal resection and sentinel node in early gastric cancer

Surgical therapy for gastric cancer involves both removal of the cancer lesion and complete lymph node dissection. Natural orifice transluminal endoscopic surgery (NOTES) is considered to represent the next revolution in surgery. Many surgeons and endoscopists believe that NOTES may be a superior alternative for early gastric cancer treatment. Sentinel node (SN) navigation surgery for gastric cancer: Single institution results of SN mapping for early gastric cancer are increasingly being considered acceptable. Furthermore, a major large-scale clinical trial of SN mapping for gastric cancer has recently been completed by The Japan Society of SN Navigation Surgery study group. They reported false negative rate of 7.0% while the sensitivity of metastasis detection based on SN status was 93%. Combination of SN biopsy and NOTES: This concept was first described by Cahill et al who proved the feasibility of lymphatic mapping and SN biopsy by NOTES. Lymphatic channel filling was immediately observable via the intraperitoneal optics. Partial resection of the stomach by hybrid NOTES: Several centers have already reported gastrectomy assisted by NOTES using the transvaginal route. However, the main problem of full-thickness resection of gastric wall remains endoscopic gastric closure. Establishing an endoscopic suturing method would be an important step toward expanding potential indications. NOTES is met with both enthusiasm and skepticism but will gain its own place as human creativity eventually provides solutions to its technical limitations. In the near future, NOTES can evolve the capacity to complement the existing armamentarium for gastric cancer surgery.