Clinical Aspect: Esophageal Cancer
If the sentinel node (SN) concept is established for esophageal cancer, SN navigation surgery will be clinically useful. The following personalized treatments will also be possible: reducing the extent of lymphadenectomy in upper mediastinal and cervical
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Yoshikazu Uenosono, Takaaki Arigami, Shigehiro Yanagita, Itaru Omoto, Ken Sasaki, Yasuto Uchikado, and Shoji Natsugoe
Abstract
If the sentinel node (SN) concept is established for esophageal cancer, SN navigation surgery will be clinically useful. The following personalized treatments will also be possible: reducing the extent of lymphadenectomy in upper mediastinal and cervical regions, targeting radiotherapy for SN, and SN sampling with endoscopic therapy. Since difficulties are associated with using the dye method for the detection of SN due to complex lymphatic flow in the esophagus and anthracosis in the lymph nodes, the radioisotope method is available for esophageal cancer. When SN navigation surgery is introduced in the clinical field, an accurate diagnosis is essential for nodal metastasis, including micrometastasis. Only a few studies have been published on the SN concept for esophageal cancer, and clinical evidence is currently not available. In our experience, the SN concept is applicable to patients with cT1 and cN0 esophageal cancer; however, the role of SN navigation surgery for clinical T2 or more remains unclear. Multicenter trials are needed in the near future in order to establish standard personalized therapy.
Y. Uenosono (*) Molecular Frontier Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan e-mail: [email protected] T. Arigami · S. Natsugoe Molecular Frontier Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan S. Yanagita · I. Omoto · K. Sasaki · Y. Uchikado Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan © Springer Nature Singapore Pte Ltd. 2019 S. Natsugoe (ed.), Lymph Node Metastasis in Gastrointestinal Cancer, https://doi.org/10.1007/978-981-10-4699-5_18
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Keywords
Sentinel node · Esophageal cancer · Lymph node metastasis · Micrometastasis · Minimally invasive surgery
18.1 Introduction Esophageal cancer has one of the greatest malignant potentials among gastrointestinal cancers and frequently metastasizes to the lymph nodes, such as the cervical or abdominal lymph nodes, which are distant from the primary tumor. Since the sites of lymph node metastases are extensively distributed, difficulties are associated with focusing on the removal of specific lymph nodes, even in superficial esophageal cancer [1]. Therefore, radical lymph node dissection such as extended three-field lymphadenectomy has been widely accepted as a treatment for esophageal cancer [2, 3]. Furthermore, esophageal cancer surgery is one of the most invasive types of digestive surgery [4, 5]. To date, endoscopic submucosal dissection (ESD) and minimally invasive surgery with thoracoscopy and laparoscopy are performed for early-stage disease
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