[Practice and reflection on sentinel lymph node navigation surgery for early gastric cancer]

Area of Science:

• Surgical Oncology
• Gastroenterology
• Medical Technology

Background:

• Minimally invasive techniques, AI, and big data are driving personalized, precise, and intelligent surgical treatments for early gastric cancer.
• Function-preserving surgeries, particularly sentinel lymph node navigation surgery, are becoming standard for early gastric cancer.
• Significant controversies persist regarding sentinel lymph node navigation surgery, including node definition, tracer selection, imaging timing, surgical scope, pathological examination, and indications for further surgery.

Purpose of the Study:

• To redefine sentinel lymph nodes in early gastric cancer based on metastasis patterns and tracer imaging.
• To recommend indocyanine green as the preferred tracer for sentinel lymph node navigation surgery.
• To provide practical suggestions for sentinel lymph node dissection, local gastrectomy, and post-operative management.

Main Methods:

• Comprehensive determination of sentinel lymph node areas using lymph node metastasis patterns and tracer imaging.
• Selection of indocyanine green as the primary tracer, with ongoing research into optimal imaging times.
• Recommendations for intraoperative frozen pathological examination of incision margins and sentinel lymph nodes, including size-based sampling strategies.

Main Results:

• Proposed redefinition of sentinel lymph nodes for early gastric cancer.
• Indocyanine green suggested as the tracer of choice.
• Specific guidelines for pathological examination and surgical strategies have been developed based on practical experience.

Conclusions:

• Sentinel lymph node navigation surgery shows promise for early gastric cancer treatment.
• Further high-quality evidence-based research is essential to validate the safety and efficacy of these refined surgical approaches.
• These advancements aim to improve surgical outcomes for early gastric cancer globally.