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Sentinel node biopsy during thoracolaparoscopic esophagectomy for advanced esophageal cancer.

Boone J, Hobbelink MG, Schipper ME, Vleggaar FP, Borel Rinkes IH, de Haas RJ, Ruurda JP, van Hillegersberg R - World J Surg Oncol (2016)

Bottom Line: Intraoperative identification rate was 38%.No adverse events related to the sentinel node biopsy were observed.Probably the real sentinel node could not be identified due to localization adjacent to the primary tumor or bypassing due to metastatic tumor involvement.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery (G04.228), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.

ABSTRACT

Background: Omitting 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.

Methods: The 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.

Results: Visualization 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.

Conclusions: In 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.

No MeSH data available.


Related in: MedlinePlus

Example of scintigraphic examination (thoracic part) performed 1 h (left) and 3 h (right) after radioactive tracer injection. A focal area of radioactivity is noticed in the left cervical region
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Fig2: Example of scintigraphic examination (thoracic part) performed 1 h (left) and 3 h (right) after radioactive tracer injection. A focal area of radioactivity is noticed in the left cervical region

Mentions: One hour and approximately 3 h after injection, static images in the anterior, posterior, and lateral planes were obtained by a dual-head gamma camera with a low-energy, high-resolution (LEHR) collimator (Argus®; Philips Medical Systems, Best, The Netherlands) to locate focal areas of radioactivity (Figs. 2 and 3).Fig. 2


Sentinel node biopsy during thoracolaparoscopic esophagectomy for advanced esophageal cancer.

Boone J, Hobbelink MG, Schipper ME, Vleggaar FP, Borel Rinkes IH, de Haas RJ, Ruurda JP, van Hillegersberg R - World J Surg Oncol (2016)

Example of scintigraphic examination (thoracic part) performed 1 h (left) and 3 h (right) after radioactive tracer injection. A focal area of radioactivity is noticed in the left cervical region
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4837514&req=5

Fig2: Example of scintigraphic examination (thoracic part) performed 1 h (left) and 3 h (right) after radioactive tracer injection. A focal area of radioactivity is noticed in the left cervical region
Mentions: One hour and approximately 3 h after injection, static images in the anterior, posterior, and lateral planes were obtained by a dual-head gamma camera with a low-energy, high-resolution (LEHR) collimator (Argus®; Philips Medical Systems, Best, The Netherlands) to locate focal areas of radioactivity (Figs. 2 and 3).Fig. 2

Bottom Line: Intraoperative identification rate was 38%.No adverse events related to the sentinel node biopsy were observed.Probably the real sentinel node could not be identified due to localization adjacent to the primary tumor or bypassing due to metastatic tumor involvement.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery (G04.228), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.

ABSTRACT

Background: Omitting 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.

Methods: The 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.

Results: Visualization 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.

Conclusions: In 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.

No MeSH data available.


Related in: MedlinePlus