Advertisement

World Journal of Surgery

, Volume 39, Issue 12, pp 2941–2947 | Cite as

Clinical Significance of Sentinel Node Positivity in Patients with Superficial Esophageal Cancer

  • Hiroya Takeuchi
  • Hirofumi Kawakubo
  • Rieko Nakamura
  • Kazumasa Fukuda
  • Tsunehiro Takahashi
  • Norihito Wada
  • Yuko Kitagawa
Original Scientific Report

Abstract

Background

Sentinel node (SN) mapping in esophageal cancer has been reported to be technically feasible with an acceptable detection rate and accuracy. However, the clinical significance and survival analysis findings associated with the metastatic status of SNs in patients with early-stage esophageal cancer have not been clarified. In this study, we investigated the clinical significance and survival impact of SN mapping in early-stage esophageal cancer.

Methods

Among patients who were diagnosed preoperatively with clinical T1N0M0 or T2N0M0 esophageal cancer and who underwent SN mapping, 70 consecutive patients who were diagnosed with pathological T1 primary thoracic esophageal cancer were enrolled in this study. Sixty-four (91 %) patients were diagnosed with squamous cell carcinoma while 5 (7 %) patients were with adenocarcinoma. Endoscopic injection of technetium-99m tin colloid was performed before surgery, and radioactive SNs were identified by preoperative lymphoscintigraphy and intraoperative gamma probing. Standard esophagectomy with lymphadenectomy was performed in all patients, and all resected nodes were evaluated by routine pathological examination.

Results

SNs were successfully detected in 65 (92.9 %) of 70 patients with pT1 esophageal cancer. The sensitivity to predict lymph node metastasis was 91.7 %, and the diagnostic accuracy based on SN status was 96.9 %. Although there was a wide distribution of SNs from cervical to abdominal areas, 84.5 % of the patients had no lymph node metastasis or had lymph node metastasis only in SN. The disease-specific survival of the patients with metastatic non-SNs was significantly worse relative to that of the patients with no lymph node metastasis or lymph node metastasis only in SN.

Conclusions

This study demonstrated that radio-guided SN mapping is useful not only as an accurate diagnostic tool for detecting lymph node metastasis but also as a tool for prognostic stratification in patients with cN0 early esophageal cancer.

Keywords

Sentinel Node Esophageal Cancer Esophageal Squamous Cell Carcinoma Sentinel Node Mapping Sentinel Node Status 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Eifel P, Axelson JA, Costa J et al (2001) National institutes of health consensus development conference statement: adjuvant therapy for breast cancer, November 1–3, 2000. J Natl Cancer Inst 93:979–989CrossRefPubMedGoogle Scholar
  2. 2.
    Yoshino I, Nakanishi R, Osaki T et al (1999) Unfavorable prognosis of patients with stage II non-small cell lung cancer associated with macroscopic nodal metastases. Chest 116:144–149CrossRefPubMedGoogle Scholar
  3. 3.
    Morton DL, Wen DR, Wong JH et al (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 127:392–399CrossRefPubMedGoogle Scholar
  4. 4.
    Giuliano AE, Kirgan DM, Guenther JM et al (1994) Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 220:391–401PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Morton DL, Thompson JF, Essner R et al (1999) Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter selective lymphadenectomy trial group. Ann Surg 230:453–463PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Krag D, Weaver D, Ashikaga T et al (1998) The sentinel node in breast cancer: a multicenter validation study. N Engl J Med 339:941–946CrossRefPubMedGoogle Scholar
  7. 7.
    Bilchik AJ, Saha S, Wiese D et al (2001) Molecular staging of early colon cancer on the basis of sentinel node analysis: a multicenter phase II trial. J Clin Oncol 19:1128–1136PubMedGoogle Scholar
  8. 8.
    Kitagawa Y, Fujii H, Mukai M et al (2000) The role of the sentinel lymph node in gastrointestinal cancer. Surg Clin N Am 80:1799–1809CrossRefPubMedGoogle Scholar
  9. 9.
    Ando N, Ozawa S, Kitagawa Y et al (2000) Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg 232:225–232PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Akiyama H, Tsurumaru M, Udagawa H et al (1994) Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg 220:360–373CrossRefGoogle Scholar
  11. 11.
    Fujita H, Kakegawa T, Yamana H et al (1995) Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Comparison of three-field lymphadenectomy with two-field lymphadenectomy. Ann Surg 222:654–662PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Fang WT, Chen WH, Chen Y et al (2007) Selective three-field lymphadenectomy for thoracic esophageal squamous carcinoma. Dis Esophagus 20:206–211CrossRefPubMedGoogle Scholar
  13. 13.
    Kitagawa Y, Fujii H, Mukai M et al (2002) Intraoperative lymphatic mapping and sentinel lymph node sampling in esophageal and gastric cancer. Surg Oncol Clin N Am 11:293–304CrossRefPubMedGoogle Scholar
  14. 14.
    Takeuchi H, Fujii H, Ando N et al (2009) Validation study of radio-guided sentinel lymph node navigation in esophageal cancer. Ann Surg 249:757–763CrossRefPubMedGoogle Scholar
  15. 15.
    Filip B, Scarpa M, Cavallin F et al (2014) Minimally invasive surgery for esophageal cancer: a review on sentinel node concept. Surg Endosc 28:1238–1249CrossRefPubMedGoogle Scholar
  16. 16.
    Japan Esophageal Society (2007) Guidelines for the clinical and pathologic studies on carcinoma of the esophagus, 10th edn. Kanehara Public Co, TokyoGoogle Scholar
  17. 17.
    Lamb PJ, Griffin SM, Burt AD et al (2005) Sentinel node biopsy to evaluate the metastatic dissemination of oesophageal adenocarcinoma. Br J Surg 92:60–67CrossRefPubMedGoogle Scholar
  18. 18.
    Uenosono Y, Arigami T, Yanagita S et al (2011) Sentinel node navigation surgery is acceptable for clinical T1 and N0 esophageal cancer. Ann Surg Oncol 18:2003–2009CrossRefPubMedGoogle Scholar
  19. 19.
    Kaburagi T, Takeuchi H, Fujii H et al (2012) Initial experience of individualized chemoradiotherapy for superficial esophageal cancers based on the sentinel lymph node concept. Esophagus 9:147–152CrossRefGoogle Scholar
  20. 20.
    Takeuchi H, Kitagawa Y (2013) New sentinel node mapping technologies for early gastric cancer. Ann Surg Oncol 20:522–532CrossRefPubMedGoogle Scholar
  21. 21.
    Kunte C, Geimer T, Baumert J et al (2011) Analysis of predictive factors for the outcome of complete lymph node dissection in melanoma patients with metastatic sentinel lymph nodes. J Am Acad Dermatol 64:655–662CrossRefPubMedGoogle Scholar
  22. 22.
    Takeuchi H, Kitagawa Y (2011) Sentinel node navigation surgery in upper gastrointestinal cancer: what can it teach us? Ann Surg Oncol 18:1812–1813CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Hiroya Takeuchi
    • 1
  • Hirofumi Kawakubo
    • 1
  • Rieko Nakamura
    • 1
  • Kazumasa Fukuda
    • 1
  • Tsunehiro Takahashi
    • 1
  • Norihito Wada
    • 1
  • Yuko Kitagawa
    • 1
  1. 1.Department of SurgeryKeio University School of MedicineTokyoJapan

Personalised recommendations