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J Thorac Cardiovasc Surg 2009;138:608-612
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

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

Brechtje A. Grotenhuis, MDa,*, Bas P.L. Wijnhoven, MD, PhDa, Ronald van Marionb, Herman van Dekken, MD, PhDb, Wim C. Hop, PhDc, Hugo W. Tilanus, MD, PhDa, J. Jan B. van Lanschot, MD, PhDa, Casper H.J. van Eijck, MD, PhDa

a Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
b Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
c Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands

Received for publication July 17, 2008; revisions received October 17, 2008; accepted for publication November 27, 2008.

* Address for reprints: Brechtje A. Grotenhuis, MD, Erasmus Medical Center, Department of Surgery, PO Box 2040, 3000 CA Rotterdam, The Netherlands. (Email: b.grotenhuis{at}erasmusmc.nl).

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.

Abbreviations and Acronyms H&E = hematoxylin-eosin; GEJ = gastroesophageal junction






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