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Frederiks, Charlotte N.; Overwater, Anouk; Bergman, Jacques J. G. H. M.; Pouw, Roos E.; de Keizer, Bart; Bennink, Roel J.; Brosens, Lodewijk A. A.; Meijer, Sybren L.; van Hillegersberg, Richard; van Berge Henegouwen, Mark I.; Ruurda, Jelle P.; Gisbertz, Suzanne S.; Weusten, Bas L. A. M.

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

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  • Medientyp: E-Artikel
  • Titel: Feasibility and Safety of Tailored Lymphadenectomy Using Sentinel Node-Navigated Surgery in Patients with High-Risk T1 Esophageal Adenocarcinoma
  • Beteiligte: Frederiks, Charlotte N.; Overwater, Anouk; Bergman, Jacques J. G. H. M.; Pouw, Roos E.; de Keizer, Bart; Bennink, Roel J.; Brosens, Lodewijk A. A.; Meijer, Sybren L.; van Hillegersberg, Richard; van Berge Henegouwen, Mark I.; Ruurda, Jelle P.; Gisbertz, Suzanne S.; Weusten, Bas L. A. M.
  • Erschienen: Springer Science and Business Media LLC, 2023
  • Erschienen in: Annals of Surgical Oncology
  • Sprache: Englisch
  • DOI: 10.1245/s10434-023-13317-6
  • ISSN: 1068-9265; 1534-4681
  • Schlagwörter: Oncology ; Surgery
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>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.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> </jats:sec>