Kitagawa Yuko, Kitajima Masaki
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Surg Technol Int. 2006;15:32-6.
Diagnostic validity of sentinel node (SN) mapping has been recently introduced into the field of various solid tumors, including gastrointestinal (GI) cancer. In gastric cancer, acceptable detection rates of SNs, as well as sensitivity in detecting micrometastasis based on SN status, was reported using the dye-guided method, as well as the radio-guided method. Gastric cancer is currently one of the suitable targets of SN navigation surgery among visceral tumors. Despite the multi-directional and complicated lymphatic flow from gastric mucosa, the anatomical situation of the stomach is relatively suitable for SN mapping in comparison with organs 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. From the data reported in the literature, micro-metastases tend to be limited within the sentinel basins in cT1N0 gastric cancer. Sentinel basins are, therefore, good targets of selective lymphadenectomy for cT1N0 gastric cancer with the potential risk of micrometastasis. Furthermore, laparoscopic local resection is theoretically feasible for curative treatment of SN negative early gastric cancer. For laparoscopic application of SN mapping of gastric cancer, a radio-guided method is essential. Although recent single institutional studies support the validity of the SN concept, a multi-centric prospective validation study based on a standardized protocol is essential for further clinical application. Currently, two major well-designed clinical trials of SN mapping for gastric cancer open surgery have been initiated in Japan. Radio-guided SN mapping for gastric cancer has a great potential to provide a new paradigm shift for surgical management of an early gastric cancer.
前哨淋巴结（SN）定位的诊断有效性最近已被引入包括胃肠道（GI）癌在内的各种实体肿瘤领域。在胃癌中，使用染料引导法和放射性引导法均报告了可接受的SN检出率，以及基于SN状态检测微转移的敏感性。目前，胃癌是内脏肿瘤中适合进行SN导航手术的靶点之一。尽管胃黏膜的淋巴引流多向且复杂，但与食管和直肠等封闭空间内的器官相比，胃的解剖情况相对适合进行SN定位。特别是，临床T1N0期胃癌似乎是尝试改变治疗方法的良好对象。从文献报道的数据来看，微转移在cT1N0期胃癌中往往局限于前哨淋巴结区域内。因此，前哨淋巴结区域是对有微转移潜在风险的cT1N0期胃癌进行选择性淋巴结清扫的良好靶点。此外，腹腔镜局部切除理论上对于SN阴性的早期胃癌的根治性治疗是可行的。对于胃癌SN定位的腹腔镜应用，放射性引导法至关重要。尽管最近的单中心研究支持SN概念的有效性，但基于标准化方案的多中心前瞻性验证研究对于进一步的临床应用至关重要。目前，日本已启动两项设计良好的关于胃癌开放手术SN定位的大型临床试验。胃癌放射性引导SN定位有很大潜力为早期胃癌的手术治疗提供新的范式转变。
