Laparoscopic sentinel node navigation surgery for early gastric cancer

Area of Science:

• Surgical Oncology
• Gastroenterology
• Cancer Diagnostics

Background:

• Sentinel node (SN) biopsy is the gold standard for detecting lymph node metastasis in early gastric cancer.
• The SN concept's validity is supported by large-scale studies like SNNS.
• Accurate SN biopsy relies on six key elements: indication, tracer selection, injection, detection, biopsy technique, and metastasis identification.

Purpose of the Study:

• To validate and optimize the elements of sentinel node biopsy for early gastric cancer.
• To evaluate the efficacy of lymphatic basin dissection and indocyanine green (ICG) fluorescence mapping.
• To assess the impact of SN biopsy on surgical approaches for early gastric cancer.

Main Methods:

• Validation of SN biopsy elements for gastric cancer, including indications (clinical T1 < 4 cm).
• Standardization of tracer methods: combination mapping (radioactive colloid and blue dye) with endoscopic submucosal injection.
• Implementation of lymphatic basin dissection for SN detection and biopsy, complemented by ICG fluorescence mapping.

Main Results:

• Lymphatic basin dissection minimizes missed SNs and enhances oncological safety as a backup to frozen section diagnosis.
• ICG fluorescence mapping offers superior sensitivity and signal stability, applicable to both open and laparoscopic gastrectomy.
• Laparoscopic SN biopsy with ICG navigation transforms early gastric cancer surgery from standard gastrectomy to function-preserving procedures like local resection with lymphatic basin dissection.

Conclusions:

• Sentinel node biopsy, particularly with lymphatic basin dissection and ICG fluorescence mapping, is a validated and effective technique for early gastric cancer.
• This approach allows for precise metastasis detection and facilitates tailored, function-preserving surgical strategies.
• SN biopsy represents a significant advancement in the surgical management of early gastric cancer, improving patient outcomes.