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World J Gastroenterol. May 21, 2014; 20(19): 5685-5693
Published online May 21, 2014. doi: 10.3748/wjg.v20.i19.5685
Sentinel lymph node navigation surgery for early stage gastric cancer
Norio Mitsumori, Hiroshi Nimura, Naoto Takahashi, Masahiko Kawamura, Hiroaki Aoki, Atsuo Shida, Nobuo Omura, Katsuhiko Yanaga
Norio Mitsumori, Hiroshi Nimura, Naoto Takahashi, Masahiko Kawamura, Hiroaki Aoki, Atsuo Shida, Nobuo Omura, Katsuhiko Yanaga, Department of surgery, the Jikei University School of Medicine, Nisi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
Author contributions: Mitsumori N, Nimura H, Kawamura M, Aoki H, Shida A and Takahashi N performed the majority of the sentinel surgery for early gastric cancer; Mitsumori N wrote the manuscript; Yanaga K and Omura N designed this study and checked the manuscript.
Correspondence to: Norio Mitsumori, MD, Department of surgery, the Jikei University School of Medicine, 3-25-8, Nisi-shinbashi, Minato-ku, Tokyo 105-8461, Japan. mitsumori@jikei.ac.jp
Telephone: +81-3-34331111 Fax: +81-3-54724140
Received: November 1, 2013
Revised: December 28, 2013
Accepted: January 20, 2014
Published online: May 21, 2014
Processing time: 198 Days and 3.1 Hours
Abstract

We attempted to evaluate the history of sentinel node navigation surgery (SNNS), technical aspects, tracers, and clinical applications of SNNS using Infrared Ray Electronic Endoscopes (IREE) combined with Indocyanine Green (ICG). The sentinel lymph node (SLN) is defined as a first lymph node (LN) which receives cancer cells from a primary tumor. Reports on clinical application of SNNS for gastric cancers started to appear since early 2000s. Two prospective multicenter trials of SNNS for gastric cancer have also been accomplished in Japan. Kitagawa et al reported that the endoscopic dual (dye and radioisotope) tracer method for SN biopsy was confirmed acceptable and effective when applied to the early-stage gastric cancer (EGC). We have previously reported the usefulness of SNNS in gastrointestinal cancer using ICG as a tracer, combined with IREE (Olympus Optical, Tokyo, Japan) to detect SLN. LN metastasis rate of EGC is low. Hence, clinical application of SNNS for EGC might lead us to avoid unnecessary LN dissection, which could preserve the patient’s quality of life after operation. The most ideal method of SNNS should allow secure and accurate detection of SLN, and real time observation of lymphatic flow during operation.

Keywords: Gastric cancer; Sentinel node navigation surgery; Infrared Ray Electronic Endoscopes; Indocyanine Green

Core tip: Two prospective multicenter trials of sentinel node navigation surgery (SNNS) for gastric cancer have been accomplished in Japan. Kitagawa et al reported that the endoscopic dual (dye and radioisotope) tracer method for SN biopsy was confirmed acceptable and effective when applied to the early-stage gastric cancer. The ideal method of SNNS should allow secure and accurate detection of sentinel lymph nodes, and real time observation of lymphatic flow during operation. In this review, we attempted to comprehensively evaluate the history, technical aspects, tracers, and clinical applications of SNNS with a special emphasis on the use of Infrared Ray Electronic Endoscopes with Indocyanine Green.