Abstract
Although sentinel node (SN) biopsy has been utilized to predict regional lymph node metastasis in patients with melanoma and breast cancer, the validity of the SN hypothesis is still controversial in regard to esophageal cancer. SN mapping for esophageal cancer is relatively complicated compared to that for gastric cancer, and the number of early-stage esophageal cancers is limited. Therefore, only a few studies have demonstrated the feasibility and validity of the SN concept for esophageal cancer. Nevertheless, our preliminary studies showed that SN mapping may be feasible in patients with early-stage esophageal cancer. Transthoracic extended esophagectomy with three-field radical lymph node dissection has been recognized as a curative procedure for thoracic esophageal cancer in Japan. However, uniform application of this highly invasive procedure might increase the morbidity and markedly reduce quality of life (QOL) after surgery. Although further accumulation of evidence based on multicenter clinical trials using standard protocol is required, SN mapping would provide significant information on individualized selective lymphadenectomy, which might reduce the morbidity and retain the patients' QOL.
Highlights
TAKEUCHI AND KITAGAWAThe Sentinel node (SN) is defined as the first lymph node(s) receiving lymphatic drainage from the primary tumor site.[6]
Esophageal cancer is the eighth most common cancer worldwide, affecting more than 450 000 people per year and for which the incidence is increasing.[1]
Patients with clinically apparent lymph node metastasis should be excluded from the indication for Sentinel node (SN) mapping because the purpose of SN mapping is to identify clinically undetectable lymph node involvement
Summary
The SN is defined as the first lymph node(s) receiving lymphatic drainage from the primary tumor site.[6]. Sentinel node mapping and biopsy were first applied to breast cancer and melanoma and subsequently attempted for other solid tumors including GI cancers.[6,7,8,9,10] SN mapping and biopsy results in reducing postoperative complications as a result of unnecessary extended lymphadenectomy in patients SN negative for cancer metastasis.[6,7]. Sentinel node mapping for esophageal cancer is technically difficult in comparison with that for gastric cancer.[10] SN mapping and biopsy might become useful tools for the accurate intraoperative diagnosis of lymph node metastasis and modification of the surgical procedures in minimally invasive surgery in patients with early‐stage esophageal cancer.[11]. In terms of the distribution of SN, they are spread widely from cervical to abdominal areas
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