Sentinel Node Mapping in Gastric Cancer Surgery

Sentinel node mapping in gastric cancer surgery is an intraoperative strategy designed to identify the first-echelon lymph nodes that directly drain a gastric tumour. By using tracer substances and specialised imaging techniques, surgeons can distinguish sentinel nodes from the wider nodal basin, enabling tailored lymphadenectomy that preserves healthy tissue, reduces operative morbidity and maintains gastric function. The technique has become increasingly integrated with minimally invasive platforms, such as laparoscopy and robotics, and benefits from advances in fluorescence guidance and nanoparticle tracers. Globally, sentinel node mapping holds promise for improving staging accuracy in early gastric cancer, guiding stomach-preserving resections and reducing the extent of lymph node dissection without compromising oncological safety. Key challenges include optimising tracer delivery, lowering false-negative rates and harmonising procedural protocols across centres to ensure reproducibility and widespread adoption.

Research from Nature Portfolio

Recent studies have demonstrated that intraoperative administration of indocyanine green and near-infrared fluorescence imaging significantly increases the number of lymph nodes retrieved during laparoscopic gastrectomy. In a phase 3 trial comparing fluorescence-guided and conventional lymphadenectomy, fluorescence guidance yielded a higher nodal harvest, lower recurrence rates and improved three-year overall and disease-free survival. These findings underscore the safety and efficacy of fluorescence-guided mapping in resectable gastric cancer and mark a shift towards more precise lymphatic staging.

Sentinel Node Mapping in Gastric Cancer Surgery publication trend

The graph below shows the total number of articles in sentinel node mapping in gastric cancer surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Sentinel lymph node: The first lymph node or group of nodes receiving lymphatic drainage from a primary tumour site, used to determine metastatic spread.

Indocyanine green fluorescence imaging: A technique in which a fluorescent dye is injected and visualised under near-infrared light to map lymphatic pathways and assess perfusion.

Lymphadenectomy: The surgical excision and pathological examination of lymph nodes to evaluate the extent of cancer dissemination.

Near-infrared fluorescence imaging: An imaging modality that detects fluorescent signals in the near-infrared spectrum, offering deep tissue penetration and low background noise for intraoperative guidance.

References

1. Indocyanine green fluorescence imaging-guided versus conventional laparoscopic lymphadenectomy for gastric cancer: long-term outcomes of a phase 3 randomised clinical trial. Nature Communications (2023).
2. Opportunities and challenges of indocyanine green in gastrointestinal cancers for intraoperative and nano-medicine application. Cancer Nanotechnology (2024).
3. Indocyanine Green (ICG) in Robotic Gastrectomy: A Retrospective Review of Lymphadenectomy Outcomes for Gastric Cancer. Cancers (2023).
4. The Use of Indocyanine Green (ICG) and Near-Infrared (NIR) Fluorescence-Guided Imaging in Gastric Cancer Surgery: A Narrative Review. Frontiers in Surgery (2022).