Laparoscopic Sentinel Lymph Node Mapping for Early Gastric Cancer

Excerpt

Sentinel lymph node (SLN) is known as the first possible site of metastasis along the route of lymphatic drainage from the primary cancerous lesion [1]. SLN mapping has been a focus of attention in management of various solid tumors to establish individualized minimally invasive surgery. In the fields of breast cancer and melanoma, several multicentric prospective randomized control trials for SLN biopsy are ongoing, and less invasive modified surgical approaches based on the SLN status have already been put into practice. However, the application of the SLN concept for gastrointestinal (GI) malignancies was not recognized until late 1990s because of high incidence of so-called skip metastasis. From the reports in recent years, we found that so-called skip metastases in GI cancers are attributed to the aberrant lymphatic drainage from the GI tract and the most of so-called skip metastases occurred in SLNs [2, 3]. Despite the multi-directional and complicated lymphatic flow from gastric mucosa, the anatomical situation of the stomach is better suited for SLN mapping than that of organs that are embedded in closed spaces, such as the esophagus and rectum. In particular, clinically T1N0 gastric cancer seems to be a good entity for which to try to modify the therapeutic approach. Several studies supporting the validity of the SLN concept for gastric cancers have been reported in the past 5 years in settings of open surgery [4,5,6]. Two major large-scale clinical trials of SLN mapping for gastric cancer in open surgery have been started in Japan. The next important issue in this field is the introduction of laparoscopic SLN mapping for early gastric cancer, to establish novel minimally invasive surgery. Laparoscopic modified surgery based on SLN status would be the goal of a minimally invasive approach for pathologically node-negative early gastric cancer. …