Advances in Sentinel Lymph Node Navigation Surgery for Early Gastric Cancer: A Narrative Exploration
Himanshu Agrawal, Himanshu Tanwar, Nikhil Gupta, Nitin AgarwalAbstract
Background:
Sentinel lymph node navigation surgery (SNNS) has emerged as a promising minimally invasive technique for early gastric cancer (EGC), aiming to preserve gastric function while ensuring oncological safety. It is based on the concept of identifying the sentinel lymph nodes that first receive drainage from the primary tumor, allowing for a more targeted lymphadenectomy. The review focuses on advancements in SNNS, including innovations in tracer techniques, lymphatic basin theory, and intraoperative diagnostic methods.
Objective:
The objective of this review is to evaluate the recent advancements in SNNS for EGC. The review aims to assess improvements in tracer techniques, such as indocyanine green (ICG) fluorescence, dual-tracer methods, and magnetic probes, and to explore the application of lymphatic basin theory to enhance diagnostic accuracy and reduce false-negative rates. Additionally, it examines the clinical outcomes from major trials to identify the benefits, challenges, and potential for broader clinical adoption of SNNS.
Materials and Methods:
A review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including studies published between 2000 and 2025. The search was conducted in major medical databases, such as PubMed, Scopus, and Cochrane Library, using search terms related to SNNS, sentinel node biopsy, gastric cancer, and diagnostic methods. Inclusion criteria focused on studies that reported clinical outcomes, tracer methods, and advancements in SNNS. Data was extracted on sensitivity, false-negative rates, clinical trial outcomes, and technological innovations in SNNS.
Results:
The review highlights that dual-tracer methods, particularly ICG combined with radioisotopes, have shown superior sensitivity and diagnostic accuracy. The integration of lymphatic basin dissection has also improved detection rates by capturing metastases in broader lymphatic regions. Novel technologies like magnetic probes and ICG fluorescence imaging have shown promise but require further validation. Major trials, including the SENORITA trial, demonstrated significant gastric preservation rates, although challenges related to false-negative results and variability in surgeon expertise remain.
Conclusion:
SNNS represents a significant advancement in EGC treatment, offering less invasive, function-preserving approaches. Although the technique has shown promise, challenges like false-negative rates, surgeon proficiency, and diagnostic standardization need to be addressed to ensure its widespread clinical adoption. Future research should focus on improving diagnostic technologies, refining surgical techniques, and providing standardized training for surgeons.