A Review on Lymphadenectomy Strategies in Early Gastric Cancer: Sentinel Node Navigation Surgery Versus Regional Lymphadenectomy

Abstract

Introduction: Conventional management of early gastric cancer (EGC) includes standard anatomical gastrectomy along with D1/D2 lymph node dissection. Despite achieving oncological excellence, this approach affects patients' quality of life. Few approaches have been developed to counter this. Most notable among these are - “Sentinel Node Navigation Surgery” (SNNS) and “Regional Lymphadenectomy” (RL). Methods and Materials: PUBMED/EMBASE/SCOPUS databases were searched with keywords - “Early Gastric Cancer”, "Lymphadenectomy Strategy”, “Sentinel Node Navigation Surgery”, “Regional Lymphadenectomy”. Animal studies, studies containing amalgamated subsets of several gastrointestinal cancers, case reports, editorials, letters, conference abstracts without sufficient data, preprints and review articles were excluded. The review only included studies published in English. Studies with available full texts were included. This review included studies conducted in hospital-based or tertiary care settings where patients with EGC underwent surgical treatment with SNNS or RL.  Objectives: The primary objective of this review was to evaluate and compare two novel lymphadenectomy strategies for EGC - SNNS and RL. The review specifically focused on several key areas - oncological safety and efficacy, diagnostic performance, “Quality of Life” (QoL), addressing technical challenges and impact of clinical factors. Results: The post hoc analysis of the SENORITA trial demonstrated superiority of SNNS over the RL approach in terms of diagnostic performance. With RL, the rate of the skip metastasis was 2.5%. Oncological safety of SNNS was found to be non-inferior to that of standard guidelines surgery. Its diagnostic accuracy was influenced by cohort demographics and certain tumor characteristics. Combination of Maruyama computer program (MCP) with SNNS yielded a 100% negative predictive value (NPV). Conclusion: Both SNNS and RL represent novel strategies, yet their potential oncological efficacy and safety profiles show notable differences. While the fixed RL approach aims to simplify the logistical burden of lymphadenectomy, the inherent risk of skip metastasis and concerns regarding its diagnostic reliability suggest that current data may be insufficient to establish its oncological adequacy without further prospective validation. Similarly, despite the function-preserving benefits of SNNS, it possesses certain pitfalls, including variable accuracy across different patient populations and specific tumor characteristics, that necessitate more extensive investigation in future clinical studies.