Mehmet Fatih Can, Gokhan Yagci, Sadettin Cetiner, Division of Gastrointestinal Surgery, Department of Surgery, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey.
World J Gastrointest Surg. 2011 Sep 27;3(9):131-7. doi: 10.4240/wjgs.v3.i9.131.
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 D(2) dissection.
前哨淋巴结导航手术（SNNS）的发展和微创外科技术的进步极大地改变了胃癌手术的现代方法。现在已经有大量关于这种临床应用的知识，但主要由单个机构的研究组成。某些染料示踪剂，如异硫蓝或专利蓝紫，已经得到了广泛的应用，并取得了显著的成功；然而，吲哚菁绿正在变得越来越流行。双示踪剂方法，即染料和放射性同位素示踪剂的同步使用，似乎优于任何单独的染料。同时，红外线电子内窥镜、荧光成像、纳米粒子和近红外技术的概念正成为特别有前途的替代技术。苏木精和伊红染色仍然是检测前哨淋巴结（SLN）转移的主要方法。一些专门的中心已经开始对这种类型的临床分析进行免疫组织化学染色，但相关的超快速处理系统的设备成本限制了其广泛应用。腹腔镜下保留胃原发肿瘤功能的切除术，结合 SLN 识别引导的淋巴结清扫，代表了早期胃癌 SNNS 的当前最高水平。cT3 期或更高期的患者仍需要标准的 D（2）清扫。
