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Sentinel Node Navigation in Gastric Cancer: Where Do We Stand?

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Abstract

Background

Early gastric cancer (EGC) is more common nowadays and is related a to low percentage of lymph node metastasis. For this reason, there is enormous interest to implicate minimally invasive approaches. Recently, special efforts have been made towards a potential intraoperative (real-time) lymph node metastasis (LNM) assessment, as nodal disease status could not be identified with precision before or during surgery. In this direction, accurate prediction of the LNM status through sentinel LN mapping has been attempted, as an approach to the intraoperative detection of sentinel lymph nodes (SLNs). A careful literature search was conducted in order to clarify the potential clinical application of SN biopsy in the gastric cancer field.

Conclusion

The real clinical application of SN biopsy in gastric cancer treatment has been more than challenging due to the “complicated” nature of gastric lymphatic drainage and the high possibility of “skip” metastasis phenomenon. Notably, sophisticated technical aspects, such as the preferred tracer used and the potential “ideal” method to verify the presence of metastases in the resected SLNs, made SN biopsy application in gastric cancer field extremely demanding. Assessing the potential role of SN navigation for gastric cancer treatment in the era of advanced technology, where the minimally invasive surgical approaches are in the top of the scientific interest, it has to be highlighted that SN navigation for gastric cancer is a topic that remains highly controversial, and the need for future clinical trials on this topic is obvious.

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References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29.

    Article  Google Scholar 

  2. Ishii K, Kinami S, Funaki K, et al. Detection of sentinel and non-sentinel lymph node micrometastases by complete serial sectioning and immunohistochemical analysis for gastric cancer. J Exp Clin Cancer Res. 2008;27:1–7.

    Article  CAS  Google Scholar 

  3. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg (Chicago, Ill: 1960). 1992;127(4):392–9.

    Article  CAS  Google Scholar 

  4. Cox CE, Pendas S, Cox JM, Joseph E, Shons AR, Yeatman T, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg. 1998;227(5):645–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Murakami T. Pathomorphological diagnosis, definition and gross classification of early gastric cancer. Gann Monogr Cancer Res. 1971;11:53–5.

    Google Scholar 

  6. Kitagawa Y, Fujii H, Mukai M, Kubota T, Ando N, Watanabe M, et al. The role of the sentinel lymph node in gastrointestinal cancer. Surg Clin North Am. 2000;80:1799–809.

    Article  CAS  PubMed  Google Scholar 

  7. Kwee RM, Kwee TC. Predicting lymph node status in early gastric cancer. Gastric Cancer. 2008;11:134–48.

    Article  PubMed  Google Scholar 

  8. Hiratsuka M, Miyashiro I, Ishikawa O, Furukawa H, Motomura K, Ohigashi H, et al. Application of sentinel node biopsy to gastric cancer surgery. Surgery. 2001;129(3):335–40.

    Article  CAS  Google Scholar 

  9. Kim MC, Kim HH, Jung GJ, Lee JH, Choi SR, Kang DY, et al. Lymphatic mapping and sentinel node biopsy using 99mTc colloid in gastric cancer. Ann Surg. 2004;239:383–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Song X, Wang L, Chen W, Pan T, Zhu H, Xu J, et al. Lymphatic mapping and sentinel node biopsy in gastric cancer. Am J Surg. 2004;187:270–3.

    Article  PubMed  Google Scholar 

  11. Nimura H, Narimiya N, Mitsumori N, Yamazaki Y, Yanaga K, Urashima M. Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer. Br J Surg. 2004;91:575–9.

    Article  CAS  PubMed  Google Scholar 

  12. Miwa K, Kinami S, Taniguchi K, Fushida S, Fujimura T, Nonomura A. Mapping sentinel nodes in patients with early-stage gastric carcinoma. Br J Surg. 2003;90:178–82.

    Article  CAS  PubMed  Google Scholar 

  13. Lianos GD, Hasemaki N, Vaggelis G, Karampa A, Anastasiadi Z, Lianou A, et al. Sentinel node navigation in gastric cancer: new horizons for personalized minimally invasive surgical oncology? Transl Gastroenterol Hepatol. 2016;1:91.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Miyashiro I. What is the problem in clinical application of sentinel node concept to gastric cancer surgery? J Gastric Cancer. 2012;12:7–12.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Miyashiro I, Hiratsuka M, Sasako M, Sano T, Mizusawa J, Nakamura K, et al. High false-negative proportion of intraoperative histological examination as a serious problem for clinical application of sentinel node biopsy for early gastric cancer: final results of the Japan Clinical Oncology Group multicenter trial JCOG0302. Gastric Cancer. 2014;17:316–23.

    Article  PubMed  Google Scholar 

  16. Lee JH, Ryu KW, Kim CG, Kim SK, Lee JS, Kook MC, et al. Sentinel node biopsy using dye and isotope double tracers in early gastric cancer. Ann Surg Oncol. 2006;13:1168–74.

    Article  PubMed  Google Scholar 

  17. Lee YJ, Ha WS, Park ST, Choi SK, Hong SC, Park JW. Which biopsy method is more suitable between a basin dissection and pick-up biopsy for sentinel nodes in laparoscopic sentinel-node navigation surgery (LSNNS) for gastric cancer? J Laparoendosc Adv Surg Tech A. 2008;18:357–63.

    Article  PubMed  Google Scholar 

  18. Park do J, Kim HH, Park YS, Lee HS, Lee WW, Lee HJ, et al. Simultaneous indocyanine green and (99m) Tc-antimony sulfur colloid-guided laparoscopic sentinel basin dissection for gastric cancer. Ann Surg Oncol. 2011;18:160–5.

    Article  PubMed  Google Scholar 

  19. Kitagawa Y, Fujii H, Kumai K, Kubota T, Otani Y, Saikawa Y, et al. Recent advances in sentinel node navigation for gastric cancer: a paradigm shift of surgical management. J Surg Oncol. 2005;90:147–51.

    Article  PubMed  Google Scholar 

  20. Gretschel S, Bembenek A, Hünerbein M, Dresel S, Schneider W, Schlag PM. Efficacy of different technical procedures for sentinel lymph node biopsy in gastric cancer staging. Ann Surg Oncol. 2007;14:2028–35.

    Article  PubMed  Google Scholar 

  21. Can MF, Yagci G, Cetiner S. Sentinel lymph node biopsy for gastric cancer: where do we stand? World J Gastrointest Surg. 2011;3:131–7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mitsumori N, Nimura H, Takahashi N, Kawamura M, Aoki H, Shida A, et al. Sentinel lymph node navigation surgery for early stage gastric cancer. World J Gastroenterol. 2014;20:5685–93.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wang Z, Dong ZY, Chen JQ, Liu JL. Diagnostic value of sentinel lymph node biopsy in gastric cancer: a meta-analysis. Ann Surg Oncol. 2012;19:1541–50.

    Article  PubMed  Google Scholar 

  24. Fujimura T, Fushida S, Tsukada T, Kinoshita J, Oyama K, Miyashita T, et al. A new stage of sentinel node navigation surgery in early gastric cancer. Gastric Cancer. 2015;18:210–7.

    Article  PubMed  Google Scholar 

  25. Xiong L, Gazyakan E, Yang W, Engel H, Hunerbein M, Kneser U, et al. Indocyanine green fluorescence-guided sentinel node biopsy: a meta-analysis on detection rate and diagnostic performance. Eur J Surg Oncol. 2014;40:843–9.

    Article  CAS  PubMed  Google Scholar 

  26. Skubleny D, Dang JT, Skulsky S, Switzer N, Tian C, Shi X, et al. Diagnostic evaluation of sentinel lymph node biopsy using indocyanine green and infrared or fluorescent imaging in gastric cancer: a systematic review and meta-analysis. Surg Endosc. 2018;32:2620–31.

    Article  PubMed  Google Scholar 

  27. Kosaka T, Ueshige N, Sugaya J, Nakano Y, Akiyama T, Tomita F, et al. Lymphatic routes of the stomach demonstrated by gastric carcinomas with solitary lymph node metastasis. Surg Today. 1999;29:695–700.

    Article  CAS  PubMed  Google Scholar 

  28. Kim DH, Choi MG, Noh JH, Sohn TS, Bae JM, Kim S. Clinical significance of skip lymph node metastasis in gastric cancer patients. Eur J Surg Oncol. 2015 Mar;41(3):339–45.

    Article  CAS  PubMed  Google Scholar 

  29. Lee SE, Lee JH, Ryu KW, Cho SJ, Lee JY, Kim CG, et al. Sentinel node mapping and skip metastases in patients with early gastric cancer. Ann Surg Oncol. 2009;16(3):603–8.

    Article  PubMed  Google Scholar 

  30. Maruyama K, Gunven P, Okabayashi K, et al. Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg. 1989;210:596–602.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Su Z, Shu K, Zheng M, Sun X, Fang Z, Wang G. Sentinel lymph node and skip metastases in gastric cancer: a prospective study. Hepatogastroenterology. 2013;60(126):1513–8.

    PubMed  Google Scholar 

  32. Arigami T, Natsugoe S, Uenosono Y, Mataki Y, Ehi K, Higashi H, et al. Evaluation of sentinel node concept in gastric cancer based on lymph node micrometastasis determined by reverse transcription-polymerase chain reaction. Ann Surg. 2006;243:341–7.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kitagawa Y, Takeuchi H, Takagi Y, Natsugoe S, Terashima M, Murakami N, et al. Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol. 2013;31(29):3704–10.

    Article  PubMed  Google Scholar 

  34. Miyashiro I, Hiratsuka M, Kishi K, Takachi K, Masahiko Y, Takenaka A, et al. Intraoperative diagnosis using sentinel node biopsy with indocyanine green dye in gastric cancer surgery: an institutional trial by experienced surgeons. Ann Surg Oncol. 2013;20:542–6.

    Article  PubMed  Google Scholar 

  35. Miyashiro I, Hiratsuka M, Sasako M, Sano T, Mizusawa J, Nakamura K, et al. High false-negative proportion of intraoperative histological examination as a serious problem for clinical application of sentinel node biopsy for early gastric cancer: final results of the Japan Clinical Oncology Group multicenter trial JCOG0302. Gastric Cancer Assoc. 2014;17:316–23.

    Article  Google Scholar 

  36. Lee YJ, Jeong SH, Hur H, Han S-U, Min JS, An JY, et al. Prospective multicenter feasibility study of laparoscopic sentinel basin dissection for organ preserving surgery in gastric cancer quality control study for surgical standardization prior to phase III trial. Medicine. 2015;94:e1894.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Shimada A, Takeuchi H, Ono T, Kamiya S, Fukuda K, Nakamura R, et al. Pylorus-preserving surgery based on the sentinel node concept in early gastric cancer. Ann Surg Oncol. 2016;23:4247–52.

    Article  PubMed  Google Scholar 

  38. Niihara M, Takeuchi H, Nakahara T, Saikawa Y, Takahashi T, Wada N, et al. Sentinel lymph node mapping for 385 gastric cancer patients. J Surg Res. 2016;200:73–81.

    Article  PubMed  Google Scholar 

  39. Takahashi N, Nimura H, Fujita T, Mitsumori N, Shiraishi N, Kitano S, et al. Laparoscopic sentinel node navigation surgery for early gastric cancer: a prospective multicenter trial. Langenbeck’s Arch Surg. 2017;402(1):27–32.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, 45110, Ioannina, Greece

    Georgios D. Lianos, Christina D. Bali, Georgios K. Glantzounis & Michail Mitsis

  2. 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece

    Natasha Hasemaki

  3. Department of Surgery, ASST Valle Olona, Gallarate, Italy

    Stefano Rausei

Authors
  1. Georgios D. Lianos
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  2. Christina D. Bali
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  3. Natasha Hasemaki
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  4. Georgios K. Glantzounis
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  5. Michail Mitsis
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  6. Stefano Rausei
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All authors contributed significantly to the work (conception, design, data acquisition, analysis, drafting, critical revision) and approved the final version of the manuscript.

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Correspondence to Georgios D. Lianos.

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Lianos, G.D., Bali, C.D., Hasemaki, N. et al. Sentinel Node Navigation in Gastric Cancer: Where Do We Stand?. J Gastrointest Canc 50, 201–206 (2019). https://doi.org/10.1007/s12029-019-00217-w

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