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Current Status of Sentinel Lymph Node Biopsy in Adenocarcinoma of the Distal Esophagus, Gastric Cardia, and Proximal Stomach

  • Stephan GretschelEmail author
  • Peter M. Schlag
Chapter
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 182)

Abstract

The resection of the adenocarcinoma of the esophagogastric junction should be considered to the extent of the lymphatic drainage. This, on the other hand, depends on the possible lymphatic metastasizing. As an adenocarcinoma of the esophagogastric junction is located along the borderline between two visceral cavities (mediastinal/abdonimal), it can, in principle, metastasize in both cavities. There is not, however, an imaging (CT, MRI, PET) that can adequately assure the detection of a beginning lymph node metastasis in particular. The sentinel lymph node biopsy could provide the beginning of a solution in this case. The initial results, with all of the necessary accompanying technical work, have been encouraging. The paper presented here provides an introduction to the challenge of the SLNB and the background of a specialized surgical therapy of the AEG. If a lymph nodal metastasis can be definitely confirmed or ruled out, many patients could be spared an unnecessary lymphadenectomy. This is especially important at the AEG because minimizing the evasiveness of the surgery with adequate radical oncological resection (e.g., without thoracotomy) would mean a substantial reduction of postoperative mortality.

Keywords

Sentinel Lymph Node Sentinel Lymph Node Biopsy Minimal Residual Disease Esophagogastric Junction Isosulfan Blue 
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. Aikou T, Natugoe S, Tenabe G, Baba M, Shimazu H (1987) Lymph drainage originating from the lower esophagus and gastric cardia as measured by radioisotope uptake in the regional lymph nodes following lymphoscintigraphy. Lymphology 20(3):145–151PubMedGoogle Scholar
  2. Ajisaka H, Miwa K (2003) Micrometastases in sentinel nodes of gastric cancer. Br J Cancer 89(4):676–680PubMedCrossRefGoogle Scholar
  3. Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr (1991) Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265(10): 1287–1289PubMedCrossRefGoogle Scholar
  4. Burian M, Stein HJ, Sendler A, Feith M, Siewert JR (2004a) Sentinel lymph node mapping in gastric and esophageal carcinomas. Chirurg 75(8): 756–760PubMedCrossRefGoogle Scholar
  5. Burian M, Stein HJ, Sendler A et al (2004b) Sentinel node detection in Barrett’s and cardia cancer. Ann Surg Oncol 11(3 Suppl):255S–258SPubMedGoogle Scholar
  6. Doekhie FS, Mesker WE, van Krieken JH et al (2005) Clinical relevance of occult tumor cells in lymph nodes from gastric cancer patients. Am J Surg Pathol 29(9):1135–1144PubMedCrossRefGoogle Scholar
  7. Dresner SM, Lamb PJ, Bennett MK, Hayes N, Griffin SM (2001) The pattern of metastatic lymph node dissemination from adenocarcinoma of the esophagogastric junction. Surgery 129(1):103–109PubMedCrossRefGoogle Scholar
  8. Ell C, May A, Gossner L et al (2000) Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus. Gastroenterology 118(4):670–677PubMedCrossRefGoogle Scholar
  9. Feith M, Stein HJ, Siewert JR (2003) Pattern of lymphatic spread of Barrett’s cancer. World J Surg 27(9):1052–1057PubMedCrossRefGoogle Scholar
  10. Gretschel S, Bembenek A, Ulmer C et al (2003) Lymphatic mapping and sentinel lymph node biopsy in gastric cancer. Chirurg 74(2):132–138PubMedCrossRefGoogle Scholar
  11. Gretschel S, Moesta KT, Hunerbein M et al (2004) New concepts of staging in gastrointestinal tumors as a basis of diagnosis and multimodal therapy. Onkologie 27(1):23–30PubMedCrossRefGoogle Scholar
  12. Gretschel S, Bembenek A, Hunerbein M et al (2007) Efficacy of different technical procedures for sentinel lymph node biopsy in gastric cancer staging. Ann Surg Oncol 14(7):2028–2035PubMedCrossRefGoogle Scholar
  13. Heeren PA, Kelder W, Blondeel I et al (2005) Prognostic value of nodal micrometastases in patients with cancer of the gastro-oesophageal junction. Eur J Surg Oncol 31(3):270–276PubMedCrossRefGoogle Scholar
  14. Horstmann O, Fuzesi L, Markus PM, Werner C, Becker H (2004) Significance of isolated tumor cells in lymph nodes among gastric cancer patients. J Cancer Res Clin Oncol 130(12):733–740PubMedCrossRefGoogle Scholar
  15. Hulscher JB, van Sandick JW, de Boer AG et al (2002) Extended transthoracic resection compared with limited transhiatal resection for ­adenocarcinoma of the esophagus. N Engl J Med 347(21): 1662–1669PubMedCrossRefGoogle Scholar
  16. Ishigami S, Natsugoe S, Uenosono Y et al (2007) Usefulness of sentinel node biopsy in laparoscopic partial gastrectomy for early gastric cancer. Hepatogastroenterology 54(79):2164–2166PubMedGoogle Scholar
  17. Ishikawa K, Yasuda K, Shiromizu A et al (2007) Laparoscopic sentinel node navigation achieved by infrared ray electronic endoscopy system in patients with gastric cancer. Surg Endosc 21(7):1131–1134PubMedCrossRefGoogle Scholar
  18. Ishizaki M, Kurita A, Kubo Y et al (2006) Evaluation of sentinel node identification with isosulfan blue in gastric cancer. Eur J Surg Oncol 32(2):191–196PubMedCrossRefGoogle Scholar
  19. Isozaki H, Kimura T, Tanaka N et al (2004) An assessment of the feasibility of sentinel lymph node-guided surgery for gastric cancer. Gastric Cancer 7(3):149–153PubMedCrossRefGoogle Scholar
  20. Kitagawa Y, Kitajima M (2005) Laparoscopic sentinel lymph node Mapping for Early Gastric Cancer. World J Surg 29:416–417Google Scholar
  21. Kitagawa Y, Ohgami M, Fujii H et al (2001) Laparoscopic detection of sentinel lymph nodes in gastrointestinal cancer: a novel and minimally invasive approach. Ann Surg Oncol 8(9 suppl):86S–89SPubMedGoogle Scholar
  22. Kitagawa Y, Fujii H, Mukai M et al (2002) Radio-guided sentinel node detection for gastric cancer. Br J Surg 89(5):604–608PubMedCrossRefGoogle Scholar
  23. Lagarde SM, Cense HA, Hulscher JB et al (2005) Prospective analysis of patients with adenocarcinoma of the gastric cardia and lymph node metastasis in the proximal field of the chest. Br J Surg 92(11):1404–1408PubMedCrossRefGoogle Scholar
  24. Lee YJ, Ha WS, Park ST et al (2008a) Which biopsy method is more suitable between a basin dissection and pick-up biopsy for sentinel nodes in laparoscopic sentinel-node navigation surgery (LSNNS) for gastric cancer? J Laparoendosc Adv Surg Tech A 18(3):357–363PubMedCrossRefGoogle Scholar
  25. Lee JH, Ryu KW, Kook MC et al (2008b) Feasibility of laparoscopic sentinel basin dissection for limited resection in early gastric cancer. J Surg Oncol 98(5):331–335PubMedCrossRefGoogle Scholar
  26. Levine EA, Shen P, Shiver SA et al (2003) Intraoperative imprint cytology for evaluation of sentinel lymph nodes from visceral malignancies. J Gastrointest Surg 7(5):687–691PubMedCrossRefGoogle Scholar
  27. Li C, Kim S, Lai JF et al (2008) Solitary lymph node metastasis in gastric cancer. J Gastrointest Surg 12(3):550–554PubMedCrossRefGoogle Scholar
  28. Matsubara T, Ueda M, Kaisaki S et al (2000) Localization of initial lymph node metastasis from carcinoma of the thoracic esophagus. Cancer 89(9): 1869–1873PubMedCrossRefGoogle Scholar
  29. Matsuda J, Kitagawa Y, Fujii H et al (2004) Significance of metastasis detected by molecular techniques in sentinel nodes of patients with gastrointestinal cancer. Ann Surg Oncol 11(3 Suppl): 250S–254SPubMedGoogle Scholar
  30. Matsumoto M, Natsugoe S, Ishigami S et al (2003) Rapid immunohistochemical detection of lymph node micrometastasis during operation for upper gastrointestinal carcinoma. Br J Surg 90(5): 563–566PubMedCrossRefGoogle Scholar
  31. Merendino KA, Dillard DH (1955) The concept of sphincter substitution by an interposed jejunal segment for anatomic and physiologic abnormalities at the esophagogastric junction; with special reference to reflux esophagitis, cardiospasm and esophageal varices. Ann Surg 142(3):486–506PubMedCrossRefGoogle Scholar
  32. Miwa K (2001) Diagnosis of the lymphatic metastasis of gastric cancer by sentinel node biopsy. Nippon Rinsho 59(suppl 4):199–203PubMedGoogle Scholar
  33. Miwa K, Kinami S, Taniguchi K et al (2003) Mapping sentinel nodes in patients with early-stage gastric carcinoma. Br J Surg 90(2):178–182PubMedCrossRefGoogle Scholar
  34. Moenig SP, Luebke T, Baldus SE et al (2005) Feasibility of sentinel node concept in gastric carcinoma: clinicopathological analysis of gastric cancer with solitary lymph node metastases. Anticancer Res 25(2B):1349–1352Google Scholar
  35. Orsenigo E, Tomajer V, Di PS et al (2008) Sentinel node mapping during laparoscopic distal gastrectomy for gastric cancer. Surg Endosc 22(1):118–121PubMedCrossRefGoogle Scholar
  36. Park DJ, Lee HJ, Lee HS et al (2006) Sentinel node biopsy for cT1 and cT2a gastric cancer. Eur J Surg Oncol 32(1):48–54PubMedCrossRefGoogle Scholar
  37. Powell J, McConkey CC (1992) The rising trend in oesophageal adenocarcinoma and gastric cardia. Eur J Cancer Prev 1(3):265–269PubMedCrossRefGoogle Scholar
  38. Saikawa Y, Otani Y, Kitagawa Y et al (2006) Interim results of sentinel node biopsy during laparoscopic gastrectomy: possible role in function-preserving surgery for early cancer. World J Surg 30(11): 1962–1968PubMedCrossRefGoogle Scholar
  39. Saito H, Sato T, Miyazaki M (2007) Extramural lymphatic drainage from the thoracic esophagus based on minute cadaveric dissections: fundamentals for the sentinel node navigation surgery for the thoracic esophageal cancers. Surg Radiol Anat 29(7):531–542PubMedCrossRefGoogle Scholar
  40. Sauvanet A, Mariette C, Thomas P et al (2005) Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors. J Am Coll Surg 201(2):253–262PubMedCrossRefGoogle Scholar
  41. Siewert JR, Stein HJ (1998) Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 85(11):1457–1459PubMedCrossRefGoogle Scholar
  42. Stein HJ, Feith M, Mueller J, Werner M, Siewert JR (2000a) Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg 232(6):733–742PubMedCrossRefGoogle Scholar
  43. Stein HJ, Feith M, Siewert JR (2000b) Cancer of the esophagogastric junction. Surg Oncol 9(1):35–41PubMedCrossRefGoogle Scholar
  44. Tonouchi H, Mohri Y, Tanaka K et al (2003) Lymphatic mapping and sentinel node biopsy during laparoscopic gastrectomy for early cancer. Dig Surg 20(5):421–427PubMedCrossRefGoogle Scholar
  45. Tonouchi H, Mohri Y, Tanaka K et al (2005) Laparoscopic lymphatic mapping and sentinel node biopsies for early-stage gastric cancer: the cause of false negativity. World J Surg 29(4): 418–421PubMedCrossRefGoogle Scholar
  46. Tonouchi H, Mohri Y, Kobayashi M et al (2007) Laparoscopy-assisted distal gastrectomy with laparoscopic sentinel lymph node biopsy after endoscopic mucosal resection for early gastric cancer. Surg Endosc 21(8):1289–1293PubMedCrossRefGoogle Scholar
  47. Uenosono Y, Natsugoe S, Ehi K et al (2005) Detection of sentinel nodes and micrometastases using radioisotope navigation and immuno­histochemistry in patients with gastric cancer. Br J Surg 92(7):886–889PubMedCrossRefGoogle Scholar
  48. Wang LB, Shen JG, Dong LF et al (2008) Laparoscopic local resection based on sentinel node evaluation for early gastric cancer: a preliminary report. J Gastrointest Surg 12(8):1359–1363PubMedCrossRefGoogle Scholar
  49. Yanagita S, Natsugoe S, Uenosono Y et al (2008) Sentinel node micrometastases have high ­proliferative potential in gastric cancer. J Surg Res 145:238–243Google Scholar
  50. Yonemura Y, Endo Y, Hayashi I et al (2007) Proliferative activity of micrometastases in the lymph nodes of patients with gastric cancer. Br J Surg 94(6):731–736PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  1. 1.Charité – Universitätsmedizin Berlin, Campus Mitte, Klinik für Allgemein-Visceral-, Gefäß- und ThoraxchirurgieBerlinGermany

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