早期胃癌行前哨淋巴结导航手术的实践与思考OA

With the continuous update and iteration of minimally invasive techniques,artificial intelli-gence and big data,the surgical treatment of early gastric cancer has gradually entered an era of indivi-dualization,precision and intelligence.Function-preserving surgeries represented by sentinel lymph node navigation surgery have gradually become the mainstream surgical options for early gastric cancer.How-ever,a great deal of controversy remains in sentinel lymph node navigation surgery regarding the definition of sentinel lymph nodes,the selection of tracers,the time of visualization,the scope and strategy of sur-gery,pathological examination,and the indications for supplementary radical surgery after surgery.Based on the current research progress and practical experience,it is suggested to comprehensively determine the sentinel lymph node area based on the lymph node metastasis pattern and the tracer imaging situation,thereby redefining the sentinel lymph nodes of early gastric cancer;It is recommended to select indocya-nine green as the tracer for sentinel lymph node navigation surgery in early gastric cancer,and the defini-tion of the imaging time of indocyanine green still needs further research for confirmation;Regarding the intraoperative frozen pathological examination of the incision margin,it is necessary to pay attention to the complete preservation of the gastric mucosa and try to avoid the ablation margin of the ultrasonic scalpel or electrocautery;Regarding the frozen pathological examination of sentinel lymph nodes during the operation,it is recommended to adopt different sampling methods based on whether the short diameter of the lymph nodes exceeds 4 mm;Based on the previous practical experience,our team has put forward suggestions in aspects such as the sentinel lymph node dissection strategy,the scope and strategy of local gastrectomy,and the indications for supplementary surgery after initial surgery.Therefore,high-quality evidence-based medical research is still needed to verify the safety and effectiveness of sentinel lymph node navigation surgery,thereby improving the surgical treatment level of early gastric cancer in China and even globally.