Dimitrios Symeonidis, George Koukoulis, Konstantinos Tepetes, Department of Surgery, University Hospital of Larissa, 41110 Larissa, Greece.
World J Gastrointest Surg. 2014 Jun 27;6(6):88-93. doi: 10.4240/wjgs.v6.i6.88.
The theory behind using sentinel node mapping and biopsy in gastric cancer surgery, the so-called sentinel node navigation surgery, is to limit the extent of surgical tissue dissection around the affected organ and subsequently the accompanied morbidity. However, obstacles on the clinical correspondence of sentinel node navigation surgery in everyday practice have occasionally alleviated researchers' interest on the topic. Only recently with the widespread use of minimally invasive surgical techniques, i.e., laparoscopic gastric cancer resections, surgical community's interest on the topic have been unavoidably reflated. Double tracer methods appear superior compared to single tracer techniques. Ongoing research is now focused on the invention of new lymph node detection methods utilizing sophisticated technology such as infrared ray endoscopy, florescence imaging and near-infrared technology. Despite its notable limitations, hematoxylin/eosin is still the mainstay staining for assessing the metastatic status of an identified lymph node. An intra-operatively verified metastatic sentinel lymph node will dictate the need for further conventional lymph node dissection. Thus, laparoscopic resection of the gastric primary tumor combined with the appropriate lymph node dissection as determined by the process of sentinel lymph node status characterization represents an option for early gastric cancer. Patients with T3 or more advanced disease should still be managed conventionally with resection plus standard lymph node dissection.
在胃癌手术中使用前哨淋巴结绘图和活检（所谓的前哨淋巴结导航手术）背后的理论是限制受影响器官周围手术组织解剖的程度，从而降低伴随的发病率。然而，在日常实践中，前哨淋巴结导航手术的临床对应存在一些障碍，偶尔会降低研究人员对此课题的兴趣。直到最近，随着微创外科技术（即腹腔镜胃癌切除术）的广泛应用，外科界对该课题的兴趣才不可避免地重新燃起。双示踪剂方法似乎优于单示踪剂技术。目前的研究重点是发明新的利用复杂技术（如红外线内窥镜、荧光成像和近红外线技术）的淋巴结检测方法。尽管存在明显的局限性，但苏木精/伊红仍然是评估鉴定淋巴结转移状态的主要染色方法。术中证实的转移性前哨淋巴结将决定是否需要进一步进行常规淋巴结清扫。因此，结合术中前哨淋巴结状态确定的适当淋巴结清扫，腹腔镜切除胃原发肿瘤是早期胃癌的一种选择。T3 期或更晚期疾病的患者仍应采用常规的切除加标准淋巴结清扫。
