Sentinel node biopsy during thoracolaparoscopic esophagectomy for advanced esophageal cancer

World Journal of Surgical Oncology

Research

Frank P. Vleggaar¹  Marguerite E. I. Schipper²  Monique G. G. Hobbelink³  Richard van Hillegersberg⁴  Inne H. M. Borel Rinkes⁴  Jelle P. Ruurda⁴  Robbert J. de Haas⁴  Judith Boone⁴ 

[1] Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands;Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands;Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands;Department of Surgery (G04.228), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands;

关键词: Esophageal cancer;    Sentinel lymph node biopsy;    Lymphatic metastasis;    Lymphadenectomy;    Minimally invasive surgery;   

DOI  :  10.1186/s12957-016-0866-9

 received in 2016-01-06, accepted in 2016-04-12,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundOmitting extensive lymph node dissection could reduce esophagectomy morbidity in patients without lymph node metastases. Sentinel node biopsy may identify abdominal or thoracic lymph node metastases, thereby differentiating treatment. Feasibility of this approach was investigated in Western European esophageal cancer patients with advanced disease, without lymph node metastases at diagnostic work-up.MethodsThe sentinel node biopsy was performed in eight esophageal cancer patients with cT1-3N0 disease. One day pre-operatively, Tc-99m-labeled nanocolloid was endoscopically injected around the tumor. Lymphoscintigraphy was performed 1 and 3 h after injection. All patients underwent robotic thoracolaparoscopic esophagectomy with two-field lymph node dissection. Intraoperatively, sentinel nodes were detected by gamma probe. The resection specimen was analyzed for remaining activity by scintigraphy and gamma probe.ResultsVisualization rates of lymphoscintigraphy 1 and 3 h after tracer injection were 88 and 100 %, respectively. Intraoperative identification rate was 38 %. Postoperative identification was possible in all patients using the gamma probe to analyze the resection specimen. In 5/8 patients, lymph node metastases were found at histopathology, none of which was detected by the sentinel node biopsy. No adverse events related to the sentinel node biopsy were observed.ConclusionsIn our advanced esophageal cancer patients who underwent thoracolaparoscopic esophagectomy, the sentinel node biopsy did not predict lymph node status. Probably the real sentinel node could not be identified due to localization adjacent to the primary tumor or bypassing due to metastatic tumor involvement. Therefore, we consider the sentinel node biopsy not feasible in advanced esophageal cancer.

【 授权许可】

CC BY   
© Boone et al. 2016