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Minimally invasive surgery for esophageal cancer: a review on sentinel node concept

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Abstract

Background

Lymphoadenectomy is a cornerstone of esophageal cancer treatment, and sentinel node (SN) biopsy (SNB) might provide surgeons with an extra tool to limit unnecessarily extended lymphadenectomy and to implement a minimally invasive approach. The aim of our study was to review all the available literature on the use of SNB in esophageal surgery for malignancy.

Methods

The review was conducted according to the PRISMA guidelines. A systematic search was performed in PubMed, EMBASE, and the Cochrane database to identify all original articles on the role of SNB in esophageal cancer. Data on methodologies, tumor stage and localization, and results were summarized and used to address relevant clinical questions related to the application of the SNB technique in esophageal cancer.

Results

Twelve studies were included, with a total of 492 patients. Different methods for SN identification were used (radionuclide, blue dye, computed tomography [CT] lymphography). The pooled values estimated using the random-effects model were, respectively: technetium-99 m overall detection rate (DR) 0.970 (95 % CI 0.814–0.996), accuracy (ACC) 0.902 (95 % CI 0.736–0.968); blue-dye DR 0.971 (95 % CI 0.890–0.993), ACC 0.790 (95 % CI 0.681–0.870); and CT lymphoscintigraphy DR 0.970 (95 % CI 0.814–0.996), ACC 0.902 (95 % CI 0.736–0.968).

Conclusion

Based on these results, the concept of SN in esophageal cancer is technically feasible with an acceptable DR and ACC, and it might be applicable in the event of early-stage adenocarcinoma of the gastroesophageal junction in patients with a high surgical risk or in a patient where an endoscopic resection is taken into consideration. Further studies focused on a single tumor type and localizations are needed in order to predict the correct utilization of this concept in minimally invasive treatment of esophageal cancer.

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Acknowledgments

The authors are very grateful to Dr. M. Apostolico, Clinical Librarian, Veneto Institute of Oncology, Padova, Italy, for his help in retrieving the studies and in defining the search strategy, and to Mrs Christina Drace for her kind help in the final editing of this manuscript.

Disclosure

This study was partially funded by an Italian Ministry of Health grant to Carlo Castoro, and a University of Medicine and Pharmacy Iasi grant (Project POSDRU /107/1.5/S/78702) to Bogdan Filip.

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Authors and Affiliations

  1. Oncological Surgery Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy

    Bogdan Filip, Marco Scarpa, Francesco Cavallin, Rita Alfieri, Matteo Cagol & Carlo Castoro

  2. Department of Surgery, University of Medicine and Pharmacy, via Gattamelata 64, 35128, Iasi, Romania

    Bogdan Filip

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  1. Bogdan Filip
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Corresponding author

Correspondence to Marco Scarpa.

Additional information

Bogdan Filip and Marco Scarpa contributed equally to this study

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Filip, B., Scarpa, M., Cavallin, F. et al. Minimally invasive surgery for esophageal cancer: a review on sentinel node concept. Surg Endosc 28, 1238–1249 (2014). https://doi.org/10.1007/s00464-013-3314-8

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  • DOI: https://doi.org/10.1007/s00464-013-3314-8

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