Sentinel lymph node detection for gastric cancer: Promise or pitfall?

Area of Science:

• Surgical Oncology
• Gastroenterology
• Pathology

Background:

• Optimal surgical management for gastric cancer, particularly lymph node dissection extent, remains debated.
• Standard D1/D2 lymphadenectomy may be excessive for early gastric cancer without metastasis, increasing risks and reducing quality of life.
• Sentinel lymph node (SLN) concept offers a potential alternative to extensive dissection.

Purpose of the Study:

• To review the current status and controversies surrounding sentinel lymph node detection in gastric cancer.
• To evaluate the feasibility and oncologic safety of sentinel node navigation surgery (SNNS).
• To provide insights for practical application and guide future research.

Main Methods:

• Review of existing literature on SLN detection in gastric cancer.
• Analysis of challenges including lymphatic drainage complexity, tracer selection, mapping, and collection methods.
• Discussion of factors contributing to false negatives, such as skip metastasis and intraoperative diagnosis reliability.

Main Results:

• Sentinel lymph node biopsy (SLNB) application in gastric cancer faces significant challenges.
• Complexity of gastric lymphatic drainage impacts tracer uptake and detection rates.
• Skip metastasis and unreliable intraoperative pathology contribute to false-negative results in SNNS.

Conclusions:

• Sentinel lymph node detection in gastric cancer is currently controversial and requires further investigation.
• Caution is advised regarding the routine implementation of SNNS until accurate and effective methods are established.
• Future research should focus on overcoming current limitations for safer and more reliable SLNB in gastric cancer.