TY - JOUR
T1 - Feasibility and Safety of Tailored Lymphadenectomy Using Sentinel Node-Navigated Surgery in Patients with High-Risk T1 Esophageal Adenocarcinoma
AU - Frederiks, Charlotte N.
AU - Overwater, Anouk
AU - Bergman, Jacques J. G. H. M.
AU - Pouw, Roos E.
AU - de Keizer, Bart
AU - Bennink, Roel J.
AU - Brosens, Lodewijk A. A.
AU - Meijer, Sybren L.
AU - van Hillegersberg, Richard
AU - van Berge Henegouwen, Mark I.
AU - Ruurda, Jelle P.
AU - Gisbertz, Suzanne S.
AU - Weusten, Bas L. A. M.
N1 - Funding Information: This study was financially supported by the Dutch Cancer Society (KWF Kankerbestrijding, Project Number 10944). Funding Information: The authors would like to thank St. Antonius Hospital (Nieuwegein, the Netherlands) and PI Medical Diagnostic Equipment B.V. (Raamsdonksveer, the Netherlands) for lending a Europrobe system for the sentinel node procedures free of charge. Publisher Copyright: © 2023, The Author(s).
PY - 2023/7
Y1 - 2023/7
N2 - 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.
AB - 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85150606786&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36959491
UR - http://www.scopus.com/inward/record.url?scp=85150606786&partnerID=8YFLogxK
U2 - https://doi.org/10.1245/s10434-023-13317-6
DO - https://doi.org/10.1245/s10434-023-13317-6
M3 - Article
C2 - 36959491
SN - 1068-9265
VL - 30
SP - 4002
EP - 4011
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 7
ER -