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Published on: December 27, 2024
Sentinel node navigation surgery in gastric cancer: Current status
Dimitrios Symeonidis1, George Koukoulis1, Konstantinos Tepetes1
1Dimitrios Symeonidis, George Koukoulis, Konstantinos Tepetes, Department of Surgery, University Hospital of Larissa, 41110 Larissa, Greece.
Abstract:
The theory behind using sentinel node mapping and biopsy in gastric cancer surgery, the so-called sentinel node navigation surgery, is to limit the extent of surgical tissue dissection around the affected organ and subsequently the accompanied morbidity. However, obstacles on the clinical correspondence of sentinel node navigation surgery in everyday practice have occasionally alleviated researchers' interest on the topic. Only recently with the widespread use of minimally invasive surgical techniques, i.e., laparoscopic gastric cancer resections, surgical community's interest on the topic have been unavoidably reflated. Double tracer methods appear superior compared to single tracer techniques. Ongoing research is now focused on the invention of new lymph node detection methods utilizing sophisticated technology such as infrared ray endoscopy, florescence imaging and near-infrared technology. Despite its notable limitations, hematoxylin/eosin is still the mainstay staining for assessing the metastatic status of an identified lymph node. An intra-operatively verified metastatic sentinel lymph node will dictate the need for further conventional lymph node dissection. Thus, laparoscopic resection of the gastric primary tumor combined with the appropriate lymph node dissection as determined by the process of sentinel lymph node status characterization represents an option for early gastric cancer. Patients with T3 or more advanced disease should still be managed conventionally with resection plus standard lymph node dissection.
Insights
Sentinel node navigation surgery in gastric cancer aims to reduce surgical morbidity. Recent advances in minimally invasive techniques and detection technologies are revitalizing interest in this approach for early-stage disease.
Area of Science:
- Oncology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Sentinel node mapping and biopsy (sentinel node navigation surgery) theoretically limit surgical dissection and associated morbidity in gastric cancer.
- Clinical application challenges have previously dampened interest, but the rise of laparoscopic techniques has reignited research.
- Double tracer methods show promise over single tracer techniques for improved accuracy.
Purpose of the Study:
- To explore the principles and evolving role of sentinel node navigation surgery in gastric cancer.
- To highlight advancements in lymph node detection technologies and their potential impact.
- To define the current applicability of sentinel node navigation surgery in early gastric cancer management.
Main Methods:
- Review of the theoretical basis for sentinel node navigation surgery.
- Discussion of advancements in minimally invasive laparoscopic gastric cancer resection.
- Overview of emerging lymph node detection technologies (e.g., infrared endoscopy, fluorescence imaging, near-infrared technology).
- Assessment of the role of hematoxylin/eosin staining in metastatic evaluation.
- Intraoperative sentinel lymph node status determination guiding further lymph node dissection.
Main Results:
- Double tracer methods are considered superior to single tracer techniques.
- New detection methods utilizing advanced technologies are under development.
- Hematoxylin/eosin staining remains the standard for lymph node metastasis assessment despite limitations.
- Intraoperative confirmation of metastasis in sentinel nodes mandates further lymph node dissection.
- Sentinel node status characterization guides tailored lymphadenectomy.
Conclusions:
- Sentinel node navigation surgery, combined with laparoscopic resection, is a viable option for early gastric cancer.
- This approach aims to minimize unnecessary lymph node dissection and reduce patient morbidity.
- For T3 or more advanced gastric cancers, conventional resection with standard lymph node dissection remains the recommended management.
