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World J Gastrointest Endosc. Apr 16, 2020; 12(4): 119-127
Published online Apr 16, 2020. doi: 10.4253/wjge.v12.i4.119
Burgeoning study of sentinel-node analysis on management of early gastric cancer after endoscopic submucosal dissection
David Friedel, Xiaocen Zhang, Stavros Nicholas Stavropoulos
David Friedel, Department of Gastroenterology, New York University Winthrop Hospital, Mineola, NY 11501, United States
Xiaocen Zhang, Department of Internal Medicine, Mount Sinai St. Luke’s West Hospital Center, New York, NY 10019, United States
Stavros Nicholas Stavropoulos, Department of Gastroenterology, Hepatology and Nutrition, NYU-Winthrop University Hospital, Mineola, NY 11501, United States
Author contributions: All authors equally contributed to this paper.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: David Friedel, AGAF, MD, Associate Professor, Associate Director, Department of Gastroenterology, New York University Winthrop Hospital, 222 Station Plaza North Suite 428, Mineola, NY 11501, United States. dfriedel@winthrop.org
Received: December 15, 2019
Peer-review started: December 15, 2019
First decision: January 6, 2020
Revised: February 18, 2020
Accepted: March 1, 2020
Article in press: March 1, 2020
Published online: April 16, 2020
Processing time: 117 Days and 1.8 Hours
Abstract

Endoscopic submucosal dissection (ESD) represents an organ-preserving alternative to surgical resection of early gastric cancer. However, even with ESD yielding en-bloc resection specimens, there are concerns regarding tumor spread such as with larger lesions, ulcerated lesions, undifferentiated pathology and submucosal invasion. Sentinel node navigational surgery (SNNS) when combined with ESD offers a minimally invasive alternative to the traditional extended gastrectomy and lymphadenectomy if lack of lymph node spread can be confirmed. This would have a clear advantage in terms of potential complications and quality of life. However, SNNS, though useful in other malignancies such as breast cancer and melanoma, may not have a sufficient sensitivity for malignancy and negative predictive value in EGC to justify this as standard practice after ESD. The results of SNNS may improve with greater standardization and more involved dissection, technological innovations and more experience and validation such that the paradigm for post-ESD resection of EGC may change and include SNNS.

Keywords: Early gastric cancer; Sentinel node; Sentinel node navigation surgery; Expanded criteria; Endoscopic submucosal dissection; Function-preserving gastrectomy; Organ preserving surgery; Lymphadenectomy

Core tip: Sentinel node navigation surgery after endoscopic submucosal dissection represents a minimally invasive approach to gastric cancer. However, this approach is controversial because it is not standardized nor has it been well validated outside of few centers in Asia. We will discuss these controversies and the potential of sentinel node navigational surgery to become an accepted diagnostic modality for select early gastric cancer patients.