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Sentinel Node Mapping in Adenocarcinoma of the Esophagogastric Junction

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Abstract

Background

The incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing, but the surgical strategy for AEG remains controversial. We hypothesized that sentinel node (SN) mapping for AEG could be validated to avoid unnecessary lymphadenectomy and permit minimally invasive surgery. We examined the feasibility of SN mapping for AEG.

Methods

We enrolled 15 patients with preoperatively diagnosed cT1 N0 M0 primary AEG (Siewert type I, N = 3; Siewert type II, N = 12) lesions measuring <4 cm in diameter. The dual tracer method employing radioactive colloid and blue dye was used to detect SNs. The distribution of SNs was compared with that of metastatic lymph nodes in 52 patients who were surgically treated without SN mapping.

Results

SNs were successfully identified in all the patients. Two patients with lymph node metastasis had positive SNs identified via an intraoperative pathological examination, and the diagnostic sensitivity and accuracy based on the SN status were both 100 %. For Siewert type II AEG, the SNs were not detected in the lower mediastinum by intraoperative gamma probing. Thus, all surgical procedures were performed via a transhiatal approach. No patient without SN metastasis experienced cancer recurrence during a 38-month median follow-up. The distribution of SNs was similar to that of lymph node metastasis in the patients who were surgically treated without SN mapping.

Conclusions

We achieved 100 % SN detection. Our results suggested that SN mapping is feasible for AEG and highly sensitive and accurate in diagnosing lymph node metastasis. SN mapping may clarify the necessity of mediastinal lymph node dissection and individualize minimally invasive surgery.

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Conflicts of interest

The authors declare no conflicts of interest. This study received no grant support.

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Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Tatsuo Matsuda, Hiroya Takeuchi, Shinichi Tsuwano & Yuko Kitagawa

  2. Department of Radiology, Keio University School of Medicine, Tokyo, Japan

    Tadaki Nakahara

  3. Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan

    Makio Mukai

Authors
  1. Tatsuo Matsuda
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  2. Hiroya Takeuchi
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  3. Shinichi Tsuwano
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  4. Tadaki Nakahara
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  5. Makio Mukai
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  6. Yuko Kitagawa
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Corresponding author

Correspondence to Hiroya Takeuchi.

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Matsuda, T., Takeuchi, H., Tsuwano, S. et al. Sentinel Node Mapping in Adenocarcinoma of the Esophagogastric Junction. World J Surg 38, 2337–2344 (2014). https://doi.org/10.1007/s00268-014-2573-4

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  • DOI: https://doi.org/10.1007/s00268-014-2573-4

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