Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Jul;30(7):4002-4011.
doi: 10.1245/s10434-023-13317-6. Epub 2023 Mar 23.

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

Charlotte N Frederiks  1   2 , Anouk Overwater  1   2 , Jacques J G H M Bergman  3 , Roos E Pouw  3 , Bart de Keizer  4 , Roel J Bennink  5 , Lodewijk A A Brosens  6 , Sybren L Meijer  7 , Richard van Hillegersberg  8 , Mark I van Berge Henegouwen  9   10 , Jelle P Ruurda  8 , Suzanne S Gisbertz  9   10 , Bas L A M Weusten  11   12
Affiliations
Multicenter Study

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

Charlotte N Frederiks et al. Ann Surg Oncol. 2023 Jul.

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.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Identification of a sentinel node located at the aortopulmonary window. A Lymphoscintigraphy 2 h after endoscopic injection of the hybrid tracer showed the injection site and an intrathoracic sentinel node. B This was combined with a SPECT-CT to detect the sentinel node location. C The thoracolaparoscopic gammaprobe confirmed high radioactivity uptake during the thoracic phase of surgery, D after which the sentinel node could be identified. E The sentinel node was also clearly visualized as indocyanine green positive when the camera view was switched to near-infrared. F Subsequently, thoracoscopic resection of the sentinel node was performed under near-infrared vision
See this image and copyright information in PMC

References

    1. Dunbar KB, Spechler SJ. The risk of lymph-node metastases in patients with high-grade dysplasia or intramucosal carcinoma in Barrett’s esophagus: a systematic review. Am J Gastroenterol. 2012;107(6):850–862. doi: 10.1038/ajg.2012.78. - DOI - PMC - PubMed
    1. Künzli H, Belghazi K, Pouw R, et al. Endoscopic management and follow-up of patients with a submucosal esophageal adenocarcinoma. United Eur Gastroenterol J. 2018;6(5):669–677. doi: 10.1177/2050640617753808. - DOI - PMC - PubMed
    1. Nieuwenhuis EA, van Munster SN, Meijer SL, et al. Analysis of metastases rates during follow-up after endoscopic resection of early “high-risk” esophageal adenocarcinoma. Gastrointest Endosc. 2022 doi: 10.1016/j.gie.2022.03.005. - DOI - PubMed
    1. Manner H, Pech O, Heldmann Y, et al. The frequency of lymph node metastasis in early-stage adenocarcinoma of the esophagus with incipient submucosal invasion (pT1b sm1) depending on histological risk patterns. Surg Endosc. 2015;29(7):1888–1896. doi: 10.1007/s00464-014-3881-3. - DOI - PubMed
    1. Boys JA, Worrell SG, Chandrasoma P, et al. Can the risk of lymph node metastases be gauged in endoscopically resected submucosal esophageal adenocarcinomas? A multi-center study. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2016;20(1):6–12. doi: 10.1007/s11605-015-2950-9. - DOI - PubMed

Publication types

Substances

Supplementary concepts

LinkOut - more resources