The sentinel node concept in adenocarcinomas of the distal esophagus and gastroesophageal junction

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 138; no. 3; pp. 608 - 612
• Main Authors: Grotenhuis, Brechtje A., MD, Wijnhoven, Bas P.L., MD, PhD, van Marion, Ronald, van Dekken, Herman, MD, PhD, Hop, Wim C., PhD, Tilanus, Hugo W., MD, PhD, van Lanschot, J. Jan B., MD, PhD, van Eijck, Casper H.J., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2009; AATS/WTSA; Elsevier
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagogastric Junction - surgery; False Negative Reactions; Feasibility Studies; Female; Hematoxylin - administration & dosage; Hematoxylin - analysis; Humans; Lymph Node Excision - methods; Lymph Nodes - pathology; Lymph Nodes - surgery; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative - methods; Neck; Pneumology; Rosaniline Dyes - administration & dosage; Rosaniline Dyes - analysis; gastroesophageal junction; hematoxylin-eosin; GEJ; H&E; 7; Adenocarcinoma; Concept; Gastroesophageal junction; Sentinel lymph node; Distal; Anesthesia; Malignant tumor; Circulatory system; Cardiology; Cancer; Esophagus
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2008.11.061

Objective The sentinel node concept is of great value in the treatment of various malignancies. In this study we investigated whether the application of the sentinel node procedure is feasible in esophageal adenocarcinoma and whether it can tailor surgical treatment of the individual patient. Methods In 40 patients with an adenocarcinoma of the distal esophagus or gastroesophageal junction, blue dye was injected around the tumor intraoperatively. Sentinel nodes (blue-stained) and nonsentinel nodes were identified and dissected during transhiatal esophagectomy. In sentinel nodes negative for tumor cells on routine hematoxylin-eosin examination, multilevel sectioning and immunohistochemical staining were performed to search for micrometastases. Results The sentinel node procedure was technically successful in 39 of 40 patients (98%). The median number of sentinel nodes identified was 4. Sentinel nodes were present in more than 1 nodal station in 8 patients (21%). In 6 patients in whom the sentinel node was negative for metastasis, nonsentinel nodes were positive for tumor cells (false-negative rate 6/39 = 15%). Micrometastases and isolated tumor cells were detected in 7 of 19 patients (37%) with sentinel nodes, but this finding did not affect the false-negative rate. Conclusion Detection of sentinel nodes is technically feasible during esophagectomy for cancer. However, given the relatively high false-negative rate of 15% and the high frequency of sentinel nodes in more than 1 nodal station, the clinical relevance of the sentinel node concept (through application of the blue dye technique) in the current treatment of patients with an adenocarcinoma of the distal esophagus or gastroesophageal junction seems limited.