Clinical Aspect: Gastric Cancer

  • Hiroya TakeuchiEmail author
  • Yuko Kitagawa


Recent meta-analyses and a prospective multicenter trial of sentinel node (SN) mapping for early gastric cancer have shown acceptable SN detection rates and accuracy of determination of lymph node status. A dual-tracer method that employs radioactive colloids and blue dyes is currently considered the most reliable method for the stable detection of SNs for early-stage gastric cancer. However the new technologies such as indocyanine green infrared or fluorescence imaging and molecular detection of occult tumor cells in SN may revolutionize the SN mapping procedures in gastric cancer. For early gastric cancer, the establishment of individualized, minimally invasive gastrectomy based on SN concept can retain the patients’ quality of life. The combination of non-exposed endoscopic wall-inversion surgery with SN mapping and lymphatic basin dissection is expected to become a promising, ideal minimally invasive, function-preserving surgery to cure patients with cN0 early gastric cancer.


Sentinel nodes Gastric cancer Laparoscopic Non-exposed endoscopic wall-inversion surgery 


  1. 1.
    Sano T, Hollowood K. Early gastric cancer: diagnosis and less invasive treatments. Scand J Surg. 2006;95:249–55.CrossRefGoogle Scholar
  2. 2.
    Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4:146–8.PubMedGoogle Scholar
  3. 3.
    Adachi Y, Shiraishi N, Shiromizu A, Shiromizu A, Bandoh T, Aramaki M, Kitano S. Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg. 2000;135:806–10.CrossRefGoogle Scholar
  4. 4.
    Shinohara T, Kanaya S, Taniguchi K, Fujita T, Yanaga K, Uyama I. Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg. 2009;144:1138–42.CrossRefGoogle Scholar
  5. 5.
    Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248:721–7.CrossRefGoogle Scholar
  6. 6.
    Kitagawa Y, Fujii H, Mukai M, Kubota T, Ando N, et al. The role of the sentinel lymph node in gastrointestinal cancer. Surg Clin North Am. 2000;80:1799–809.CrossRefGoogle Scholar
  7. 7.
    Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.CrossRefGoogle Scholar
  8. 8.
    Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–401.CrossRefGoogle Scholar
  9. 9.
    Bilchik AJ, Saha S, Wiese D, et al. Molecular staging of early colon cancer on the basis of sentinel node analysis: a multicenter phase II trial. J Clin Oncol. 2001;19:1128–36.CrossRefGoogle Scholar
  10. 10.
    Kitagawa Y, Takeuchi H, Takagi Y, Natsugoe S, Terashima M, Murakami N, Fujimura T, Tsujimoto H, Hayashi H, Yoshimizu N, Takagane A, Mohri Y, Nabshima K, Uenosono Y, Kinami S, Sakamoto J, Morita S, Aikou T, Miwa K, Kitajima M. Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol. 2013;31:3704–10.CrossRefGoogle Scholar
  11. 11.
    Takeuchi H, Kitagawa Y. New sentinel node mapping technologies for early gastric cancer. Ann Surg Oncol. 2013;20:522–32.CrossRefGoogle Scholar
  12. 12.
    Kinami S, Fujimura T, Ojima E, Fushida S, Ojima T, Funaki H, Fujita H, Takamura H, Ninomiya I, Nishimura G, Kayahara M, Ohta T, Yoh Z. PTD classification: proposal for a new classification of gastric cancer location based on physiological lymphatic flow. Int J Clin Oncol. 2008;13:320–9.CrossRefGoogle Scholar
  13. 13.
    Tajima Y, Murakami M, Yamazaki K, Masuda Y, Kato M, Sato A, Goto S, Otsuka K, Kato T, Kusano M. Sentinel node mapping guided by indocyanine green fluorescence imaging during laparoscopic surgery in gastric cancer. Ann Surg Oncol. 2010;17:1787–93.CrossRefGoogle Scholar
  14. 14.
    Ishikawa K, Yasuda K, Shiromizu T, Etoh T, Shiraishi N, Kitano S. Laparoscopic sentinel node navigation achieved by infrared ray electronic endoscopy system in patients with gastric cancer. Surg Endosc. 2007;21:1131–4.CrossRefGoogle Scholar
  15. 15.
    Nimura H, Narimiya N, Mitsumori N, Yamazaki Y, Yanaga K, Urashima M. Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer. Br J Surg. 2004;91:575–9.CrossRefGoogle Scholar
  16. 16.
    Miyashiro I, Miyoshi N, Hiratsuka M, Kishi K, Yamada T, Ohue M, Ohigashi H, Yano M, Ishikawa O, Imaoka S. Detection of sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging: comparison with infrared imaging. Ann Surg Oncol. 2008;15:1640–3.CrossRefGoogle Scholar
  17. 17.
    Wang Z, Dong ZY, Chen JQ, Liu JL. Diagnostic value of sentinel lymph node biopsy in gastric cancer: a meta-analysis. Ann Surg Oncol. 2012;19:1541–50.CrossRefGoogle Scholar
  18. 18.
    Takeuchi H, Kitajima M, Kitagawa Y. Sentinel lymph node as a target of molecular diagnosis of lymphatic micrometastasis and local immunoresponse to malignant cells. Cancer Sci. 2008;99:441–50.CrossRefGoogle Scholar
  19. 19.
    Yanagita S, Natsugoe S, Uenosono Y, et al. Detection of micrometastases in sentinel node navigation surgery for gastric cancer. Surg Oncol. 2008;17:203–10.CrossRefGoogle Scholar
  20. 20.
    Matsuda J, Kitagawa Y, Fujii H, et al. Significance of metastasis detected by molecular techniques in sentinel nodes of patients with gastrointestinal cancer. Ann Surg Oncol. 2004;11:250–4.CrossRefGoogle Scholar
  21. 21.
    Xu X, Roberts SA, Pasha TL, Zhang PJ. Undesirable cytokeratin immunoreactivity of native nonepithelial cells in sentinel lymph nodes from patients with breast carcinoma. Arch Pathol Lab Med. 2000;124:1310–3.PubMedGoogle Scholar
  22. 22.
    Isozaki H, Okajima K, Fujii K. Histological evaluation of lymph node metastasis on serial sectioning in gastric cancer with radical lymphadenectomy. Hepato-Gastroenterology. 1997;44:1133–6.Google Scholar
  23. 23.
    Morita D, Tsuda H, Ichikura T, et al. Analysis of sentinel node involvement in gastric cancer. Clin Gastroenterol Heapatol. 2007;5:1046–52.CrossRefGoogle Scholar
  24. 24.
    Cochran AJ, Robert A, Wen DR et al. Accurate evaluation of nodal tissues for the presence of tumor is central to the sentinel node approach. Selective sentinel lymphadenectomy for human solid cancer. Cancer treatment and research. Springer: New York; 2005.Google Scholar
  25. 25.
    Pantel K, Cote RJ, Fodstad O. Detection and clinical importance of micrometastatic disease. J Natl Cancer Inst. 1999;91:1113–24.CrossRefGoogle Scholar
  26. 26.
    Arigami T, Natsugoe S, Uenosono Y, et al. Evaluation of sentinel node concept in gastric cancer based on lymph node micrometastasis determined by reverse transcription-polymerase chain reaction. Ann Surg. 2006;243:341–7.CrossRefGoogle Scholar
  27. 27.
    Shimizu Y, Takeuchi H, Sakakura Y, et al. Molecular detection of sentinel node micrometastases in patients with clinical N0 gastric carcinoma with real-time multiplex reverse transcription-polymerase chain reaction assay. Ann Surg Oncol. 2012;19:469–77.CrossRefGoogle Scholar
  28. 28.
    Kumagai K, Yamamoto N, Miyashiro I, et al. Multicenter study evaluating the clinical performance of the OSNA assay for the molecular detection of lymph node metastases in gastric cancer patients. Gastric Cancer. 2014;17:273–80.CrossRefGoogle Scholar
  29. 29.
    Ishigami S, Natsugoe S, Tokuda K, et al. Clinical impact of micrometastasis of the lymph node in gastric cancer. Am Surg. 2003;69:573–7.PubMedGoogle Scholar
  30. 30.
    Fukagawa T, Sasako M, Ito S, et al. The prognostic significance of isolated tumor cells in the lymph nodes of gastric cancer patients. Gastric Cancer. 2010;13:191–6.CrossRefGoogle Scholar
  31. 31.
    Yanagita S, Natsugoe S, Uenosono Y, et al. Sentinel node micrometastases have high proliferative potential in gastric cancer. J Surg Res. 2008;145:238–43.CrossRefGoogle Scholar
  32. 32.
    Takeuchi H, Saikawa Y, Kitagawa Y. Laparoscopic sentinel node navigation surgery for early gastric cancer. Asian J Endosc Surg. 2009;2:13–7.CrossRefGoogle Scholar
  33. 33.
    Takeuchi H, Oyama T, Kamiya S, Nakamura R, Takahashi T, Wada N, Saikawa Y, Kitagawa Y. Laparoscopy-assisted proximal gastrectomy with sentinel node mapping for early gastric cancer. World J Surg. 2011;35:2463–71.CrossRefGoogle Scholar
  34. 34.
    Takeuchi H, Kitagawa Y. Sentinel node navigation surgery in patients with early gastric cancer. Dig Surg. 2013;30:104–11.CrossRefGoogle Scholar
  35. 35.
    Park JY, Kim YW, Ryu KW, Nam BH, Lee YJ, Jeong SH, Park JH, Hur H, Han SU, Min JS, An JY, Hyung WJ, Cho GS, Jeong GA, Jeong O, Park YK, Jung MR, Yoon HM, Eom BW. Assessment of laparoscopic stomach preserving surgery with sentinel basin dissection versus standard gastrectomy with lymphadenectomy in early gastric cancer—a multicenter randomized phase III clinical trial (SENORITA trial) protocol. BMC Cancer. 2016;16:340.CrossRefGoogle Scholar
  36. 36.
    Mayanagi S, Takeuchi H, Kamiya S, Niihara M, Nakamura R, Takahashi T, Wada N, Kawakubo H, Saikawa Y, Omori T, Nakahara T, Mukai M, Kitagawa Y. Suitability of sentinel node mapping as an index of metastasis in early gastric cancer following endoscopic resection. Ann Surg Oncol. 2014;21:2987–93.CrossRefGoogle Scholar
  37. 37.
    Goto O, Takeuchi H, Kawakubo H, Sasaki M, Matsuda T, Matsuda S, Kigasawa Y, Kadota Y, Fujimoto A, Ochiai Y, Horii J, Uraoka T, Kitagawa Y, Yahagi N. First case of non-exposed endoscopic wall-inversion surgery with sentinel node basin dissection for early gastric cancer. Gastric Cancer. 2015;18:440–5.CrossRefGoogle Scholar
  38. 38.
    Takeuchi H, Kitagawa Y. Sentinel lymph node biopsy in gastric cancer. Cancer J. 2015;21:21–4.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of SurgeryHamamatsu University School of MedicineShizuokaJapan
  2. 2.Department of SurgeryKeio University School of MedicineTokyoJapan

Personalised recommendations