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World J Gastrointest Surg. Sep 27, 2011; 3(9): 131-137
Published online Sep 27, 2011. doi: 10.4240/wjgs.v3.i9.131
Sentinel lymph node biopsy for gastric cancer: Where do we stand?
Mehmet Fatih Can, Gokhan Yagci, Sadettin Cetiner
Mehmet Fatih Can, Gokhan Yagci, Sadettin Cetiner, Division of Gastrointestinal Surgery, Department of Surgery, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey
Author contributions: Can MF designed the study and drafted the manuscript; Yagci G revised the manuscript and contributed to the final approval of the paper; Cetiner S contributed to the conception and design of the study and gave final approval of the paper.
Correspondence to: Mehmet Fatih Can, MD, FICS, Assistant Professor, Division of Gastrointestinal Surgery, Department of Surgery, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey.
Telephone: +90-532-5585934 Fax: +90-312-2564756
Received: June 9, 2011
Revised: August 27, 2011
Accepted: September 12, 2011
Published online: September 27, 2011

Development of sentinel node navigation surgery (SNNS) and advances in minimally invasive surgical techniques have greatly shaped the modern day approach to gastric cancer surgery. An extensive body of knowledge now exists on this type of clinical application but is principally composed of single institute studies. Certain dye tracers, such as isosulfan blue or patent blue violet, have been widely utilized with a notable amount of success; however, indocyanine green is gaining popularity. The double tracer method, a synchronized use of dye and radio-isotope tracers, appears to be superior to any of the dyes alone. In the meantime, the concepts of infrared ray electronic endoscopy, florescence imaging, nanoparticles and near-infrared technology are emerging as particularly promising alternative techniques. Hematoxylin and eosin staining remains the main method for the detection of sentinel lymph node (SLN) metastases. Several specialized centers have begun to employ immunohistochemical staining for this type of clinical analysis but the equipment costs involving the associated ultra-rapid processing systems is limiting its widespread application. Laparoscopic function-preserving resection of primary tumor from the stomach in conjunction with lymphatic basin dissection navigated by SLN identification represents the current paramount of SNNS for early gastric cancer. Patients with cT3 stage or higher still require standard D2 dissection.

Keywords: Sentinel lymph node biopsy, Gastric cancer, Laparoscopy, Lymph node dissection, Lymphatic metastasis, Staining and labeling