Many patients with early gastric cancer are currently treated with advanced laparoscopic gastrectomy procedures, such as laparoscopy-assisted distal gastrectomy (LADG) and laparoscopy-assisted total gastrectomy, in many countries.1-4 Advanced laparoscopic gastrectomy contributes to both better aesthetics and early postoperative recovery.5 However, the patients’ quality of life (QOL) is mainly affected by late phase complications, such as dumping syndrome and body weight loss resulting from disturbances in oral intake. Therefore, both a minimal invasive approach for early-phase recovery and satisfactory late-phase function after gastric cancer surgery should be carefully considered in patients indicated for these procedures.
Although function-preserving gastrectomy, such as partial gastrectomy, segmental gastrectomy, and proximal gastrectomy, with limited stomach resection and lymph node dissection may help to improve postoperative late phase function, a certain incidence of skip metastasis in the first or third compartment of regional lymph nodes remains an obstacle to the wider application of these procedures. To overcome these issues, the concept of sentinel node (SN) mapping is anticipated to become a novel diagnostic tool for the identification of clinically undetectable lymph node metastasis in patients with early gastric cancer.6-8
Sentinel nodes are defined as the first draining lymph nodes from the primary site of a tumor6 and are thought to be the first possible site of micrometastasis along the route of lymphatic drainage from the primary lesion. Therefore, the pathological status of SNs can theoretically predict the status of all regional lymph nodes. If SNs are recognizable and negative for cancer metastasis, unnecessary radical lymph node dissection can be avoided. SN navigation surgery is defined as a novel, minimally invasive surgery based on SN mapping and the SN-targeted diagnosis of nodal metastasis. This surgery can prevent unnecessary lymph node dissection, thus preventing associated complications and improving the patients’ QOL.
Sentinel node mapping and biopsy were first applied to patients with melanoma and breast cancer and were subsequently extended to patients with many other solid tumors.6-8 The clinical application of SN mapping for early gastric cancer has remained controversial for years. However, results from single institutional studies, including those from our report and those from a recent multicenter trial of SN mapping for early gastric cancer, are considered acceptable in terms of the SN detection rate and the accuracy of determination of the lymph node status.9,10 On the basis of these results, we developed a novel, laparoscopic, minimally invasive gastrectomy technique combined with SN mapping.
LAPAROSCOPIC SENTINEL NODE BIOPSY FOR EARLY GASTRIC CANCER
A dual-tracer method that utilizes radioactive colloids and blue dyes is currently considered the most reliable method for the stable detection of SNs in patients with early gastric cancer.10,11 The accumulation of radioactive colloids facilitates the identification of SNs even in resected specimens, and the blue dye is effective for the intraoperative ...