The exact status of lymph node metastasis (LNM) in early gastric cancer (EGC) is crucial to determine the optimal therapeutic options in these patients because the incidence of LNM in EGC is only around 10 – 20%. However， unfortunately there are no accurate diagnostic modalities to predict the LNM in EGC good enough to select the optimal therapy. Until now the treatment guideline of EGC are ESD or radical surgery depending on preoperative factors.(1) Some portion of patients after ESD has to be converted to the radical surgery due to the risk of LNM and most of initially gastrectomized patients do not have LNM. (2， 3) For the selection of optimal therapeutic options in EGC based on exact prediction of LNM， several methods were suggested and nomogram is the one of them. The first published nomogram to predict LNM is from Zheng， et al and then several series of nomogram were studied adding additional laboratory factors. (4-9) Still these prediction models are not yet adopted for practice. 

 

Another promising method of LMN prediction is the sentinel node navigation surgery (SNNS). Even the meta-analysis of SNNS have some critics and failed Japanese multicenter trial， the large scale feasibility study in Japan showed promising results and the phase II study from Korea also showed the possibility of clinical application. (10-13) Based on these findings Korean SENORITA (Sentinel Node Oriented Tailored Approach) study group did the phase III trial comparing the standard laparoscopic gastrectomy with laparoscopic SNNS surgery. (14) After finishing the quality control study prior to phase III trial， qualified institutes enrolled phase III patients and completed the enrollment last year and follow up is ongoing for primary endpoint of 3year disease free survival. (15， 16)  

 

 

1.Japanese Gastric Cancer Association. Japanese gastric cancer treatment guideline 2014 (ver.4). Gastric Cancer 2017;20:1-19

 

2.Son SY， Park JY， Ryu KW， et al. The risk factors for lymph node metastasis in early gastric cancer patients who underwent endoscopic resection: Is the minimal lymph node dissection applicable? A retrospective study. Surg Endosc 2013;27(9):3247-3253.

 

3.Park JY， Ryu KW， Eom BW， et al. Proposal of the surgical options for primary tumor control during sentinel node navigation surgery based on the discrepancy between preoperative and postoperative early gastric cancer diagnosis. Ann Surg Oncol 2014;21(4):1123-1129

 

4.Zheng Z， Zhang Y， Zhang L， et al. Nomogram for predicting lymph node metastasis rate of submucosal gastric cancer by analyzing clinicopathological characteristics associated with lymph node metastasis. Chin J Cancer Res 2015;27(6):572-579

 

5.Zheng Z， Zhang Y， Zhang L， et al. A nomogram for predicting the likelihood of lymph node metastasis in early gastric patients. BMC Cancer 2016;16:92

 

6.Zhao LY， Yin Y， Li X， et al. A nomogram composed of clinicopathologic features and preoperative serum tumor markers to predict lymph node metastasis in early gastric cancer patients. Oncotarget 2016;7(37):59630-59639

 

7.Eom BW， Joo J， Park B， et al. Nomogram incorporating CD44v6 and clinicopathological factors to predict lymph node metastasis for early gastric cancer. PLOS One 2016;11(8):e0159424

 

8.Guo CG， Chen YJ， Ren H， et al. A nomogram for predicting the likelihood of lymph node metastasis in early gastric signet ring cell carcinoma. A single center retrospective analysis with external validation. Medicine 2016;95(46):e5393

 

9.Chen S， Nie RC， OuYang LY， et al. Nomogram analysis and external validation to predict the risk of lymph node metastasis in gastric cancer. Oncotarget 2017 online

 

10.Ryu KW， Eom BW， Nam BH， et al. Is the sentinel node biopsy clinically applicable for limited lymphadenectomy and modified gastric resection in gastric cancer? A meta-analysis of feasibility studies. J Surg Oncol 2011;104:578-584

 

11.Miyashiro I， Hiratsuka M， Sasako M， et al. High false-negative proportion of intraoperative histological examination as a serious problem for the clinical application of sentinel node biopsy for early gastric cancer: final results of the Japan Clinical Oncology Group multicenter trial JCOG0302. Gastric cancer 2014;17(2)316-323. 

 

12.Kitagawa Y， Takeuchi H， Takagi Y， et al. Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol 2013;31(29):3704-3710. 

 

13.Park DJ， et al. Phase II， prospecitive， single-arm， single-institutional， open-label clinical trial on laparoscopic sentinel node navigation surgery in early gastric cancer. 2017 Gastrointestinal Cancer Symposium， proceeding. 

 

14.Park JY， Kim YW， Ryu KW， et al. 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 trials (SENORITA trial) protocol. BMC Cancer 2016;16:340 

 

15.Lee YJ， Jeong SH， Hur H， et al. Prospective multicenter feasibility study of laparoscopic sentinel basin dissection for organ preserving surgery in gastric cancer: Quality control study for surgical standardization prior to phase III trial. Medicine 2015;94(43):e1894

 

16.<http://www.clinicaltrials.gov/ct2/show/NCT01804998 accessed on March 6， 2017>