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

• Published in: Surgical oncology Vol. 33; pp. 1 - 6
• Main Authors: Wei, Jingtao, Bu, Zhaode
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.06.2020; Elsevier Limited
• Subjects: Accuracy; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Biopsy; Cancer; Cancer therapies; Dyes; Gamma rays; Gastrectomy; Gastrectomy - methods; Gastric cancer; Humans; Light; Lymph Node Excision - methods; Lymph nodes; Lymphatic drainage; Lymphatic system; Mapping; Melanoma; Metastases; Metastasis; Morbidity; Neoplasm Recurrence, Local; Neoplasm Staging; Quality of life; Radioisotopes; Researchers; Sentinel lymph node; Sentinel Lymph Node Biopsy - methods; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Sulfur; Surgery; Systematic review; Tracers; Sentinel lymph node; Gastric cancer
• ISSN: 0960-7404; 1879-3320
• DOI: 10.1016/j.suronc.2019.12.005

At present, optimal surgery for gastric cancer is still under debate, especially the extent of lymph node dissection. Gastrectomy with D1/D2 lymphadenectomy is standard treatment for resectable advanced gastric cancer. However, in early gastric cancer without lymph node metastasis, gastrectomy with D1/D2 lymphadenectomy may not be unnecessary, which could increases morbidity and mortality and reduces the quality of life (QOL). Therefore, the concept of sentinel lymph node could be applied in gastric cancer. But due to the complexity of gastric lymphatic drainage, there are still many issues under debate, such as suitable tracers, the method of mapping and collecting and the oncologic safety of sentinel node navigation surgery (SNNS). In addition, skip metastasis and unreliability of intraoperative pathological diagnosis are two main reasons for false negative cases. In this review, we summarize the current status and controversy of sentinel lymph node detection in gastric cancer, attempting to help with practical application. Further, we hold opinion that we should be cautious about performing sentinel lymph node detection in gastric cancer before an accurate and effective method occurs. •Dual tracers seem to be the most effective way.•Skip metastasis and intraoperative diagnosis are reasons for false negative cases.•Sentinel basin dissection can reduce the false negative rate.•The oncologic safety of SNNS remains to be further studied.