World Journal of Surgery

, Volume 38, Issue 9, pp 2337–2344

Sentinel Node Mapping in Adenocarcinoma of the Esophagogastric Junction

  • Tatsuo Matsuda
  • Hiroya Takeuchi
  • Shinichi Tsuwano
  • Tadaki Nakahara
  • Makio Mukai
  • Yuko Kitagawa
Article

DOI: 10.1007/s00268-014-2573-4

Cite this article as:
Matsuda, T., Takeuchi, H., Tsuwano, S. et al. World J Surg (2014) 38: 2337. doi:10.1007/s00268-014-2573-4

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.

Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Tatsuo Matsuda
    • 1
  • Hiroya Takeuchi
    • 1
  • Shinichi Tsuwano
    • 1
  • Tadaki Nakahara
    • 2
  • Makio Mukai
    • 3
  • Yuko Kitagawa
    • 1
  1. 1.Department of SurgeryKeio University School of MedicineShinjuku-kuJapan
  2. 2.Department of RadiologyKeio University School of MedicineTokyoJapan
  3. 3.Division of Diagnostic PathologyKeio University School of MedicineTokyoJapan

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