Feasibility and Safety of Tailored Lymphadenectomy Using Sentinel Node-Navigated Surgery in Patients with High-Risk T1 Esophageal Adenocarcinoma.

Abstract

BACKGROUND:

Selective lymphadenectomy using sentinel node-navigated surgery (SNNS) might offer a less invasive alternative to esophagectomy in patients with high-risk T1 esophageal adenocarcinoma (EAC). The aim of this study was to evaluate the feasibility and safety of a new treatment strategy, consisting of radical endoscopic resection of the tumor followed by SNNS.

METHODS:

In this multicenter pilot study, ten patients with a radically resected high-risk pT1cN0 EAC underwent SNNS. A hybrid tracer of technetium-99m nanocolloid and indocyanine green was injected endoscopically around the resection scar the day before surgery, followed by preoperative imaging. During surgery, sentinel nodes (SNs) were identified using a thoracolaparoscopic gammaprobe and fluorescence-based detection, and subsequently resected. Endpoints were surgical morbidity and number of detected and resected (tumor-positive) SNs.

RESULTS:

Localization and dissection of SNs was feasible in all ten patients (median 3 SNs per patient, range 1-6). The concordance between preoperative imaging and intraoperative detection was high. In one patient (10%), dissection was considered incomplete after two SNs were not identified intraoperatively. Additional peritumoral SNs were resected in four patients (40%) after fluorescence-based detection. In two patients (20%), a (micro)metastasis was found in one of the resected SNs. One patient experienced neuropathic thoracic pain related to surgery, while none of the patients developed functional gastroesophageal disorders.

CONCLUSIONS:

SNNS appears to be a feasible and safe instrument to tailor lymphadenectomy in patients with high-risk T1 EAC. Future research with long-term follow-up is warranted to determine whether this esophageal preserving strategy is justified for high-risk T1 EAC.

• Authors: Charlotte N Frederiks, Anouk Overwater, Jacques J G H M Bergman, Roos E Pouw, Bart de Keizer, Roel J Bennink, Lodewijk A A Brosens, Sybren L Meijer, Richard van Hillegersberg, Mark I van Berge Henegouwen, Jelle P Ruurda, Suzanne S Gisbertz, Bas L A M Weusten
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 30 Issue 7 Pg. 4002-4011 (Jul 2023) ISSN: 1534-4681 [Electronic] United States
• PMID: 36959491 (Publication Type: Multicenter Study, Journal Article)
• Copyright: © 2023. The Author(s).

Chemical References

• Indocyanine Green

Topics

• Humans
• Sentinel Lymph Node Biopsy (methods)
• Feasibility Studies
• Pilot Projects
• Lymph Node Excision (methods)
• Indocyanine Green
• Adenocarcinoma (diagnostic imaging, surgery, pathology)
• Lymph Nodes (pathology)