Endoscopic treatment combined with laparoscopic sentinel node mapping for superficial gastrointestinal cancers

Endoscopic mucosal resection (EMR) has been established as a minimally invasive treatment for mucosal gastrointestinal cancer with no risk of lymph node metastasis. Recent advances in endoscopic technologies and devices, including the development of endoscopic submucosal dissection (ESD), have improved local control of superficial gastrointestinal cancer. Novel technologies in endoscopic treatments allow us to resect wider and deeper gastrointestinal cancer lesions. A current major limitation of EMR/ESD is the risk of micrometastasis in regional lymph nodes. To resolve this issue, attention has been focused on the concept of sentinel nodes. The first possible sites of metastasis along the lymphatic drainage route from the primary lesion are known as sentinel nodes. In the past 5 years, a number of single-center studies have been published that support the validity of the sentinel node concept for gastrointestinal cancers. The combination of EMR/ESD and laparoscopic/thoracoscopic sentinel node mapping seems to be a breakthrough that can extend the indication for the endoscopic treatment of gastrointestinal cancers with a potential risk of lymph node metastasis. Although there are several technical obstacles to overcome, this strategy has great potential in the near future as a novel minimally invasive treatment for superficial gastrointestinal cancers.