Your browser doesn't support javascript.
loading
Pilot-study on the feasibility of sentinel node navigation surgery in combination with thoracolaparoscopic lymphadenectomy without esophagectomy in early esophageal adenocarcinoma patients.
Künzli, H T; van Berge Henegouwen, M I; Gisbertz, S S; van Esser, S; Meijer, S L; Bennink, R J; Wiezer, M J; Seldenrijk, C A; Bergman, J J G H M; Weusten, B L A M.
Afiliación
  • Künzli HT; Department of Gastroenterology and Hepatology.
  • van Berge Henegouwen MI; Department of Gastroenterology and Hepatology.
  • Gisbertz SS; Department of Surgery.
  • van Esser S; Department of Surgery.
  • Meijer SL; Department of Surgery.
  • Bennink RJ; Department of Pathology.
  • Wiezer MJ; Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands.
  • Seldenrijk CA; Department of Surgery.
  • Bergman JJGHM; Department of Pathology, Pathology-DNA, St. Antonius Hospital, Nieuwegein.
  • Weusten BLAM; Department of Gastroenterology and Hepatology.
Dis Esophagus ; 30(11): 1-8, 2017 Nov 01.
Article en En | MEDLINE | ID: mdl-28881907
ABSTRACT
High-risk submucosal esophageal adenocarcinoma's might be treated curatively by means of radical endoscopic resection, followed by thoracolaparoscopic lymphadenectomy without concomitant esophagectomy. A preclinical study has shown the feasibility and safety of this approach; however, no studies are performed in a clinical setting. In addition, sentinel node navigation surgery could be valuable in tailoring the extent of the lymphadenectomy. This study aimed to evaluate the feasibility and safety of thoracolaparoscopic lymphadenectomy without esophagectomy (phase I) and sentinel node navigation surgery (phase II) in patients with early esophageal adenocarcinoma. Patients with T1N0M0 early esophageal adenocarcinoma scheduled for esophagectomy without neoadjuvant therapy were included. Phase I Two-field, esophagus preserving, thoracolaparoscopic lymphadenectomy was performed, followed by esophagectomy in the same session. Primary outcome parameters were the number of lymph nodes resected, and number of retained lymph nodes in the esophagectomy specimen. Phase II A radioactive tracer was injected endoscopically the day before surgery. Static imaging was performed 15 and 120 minutes after injection. The day of surgery, sentinel node navigation surgery followed by esophagectomy was performed. Primary outcome parameters were the percentage of patients with a detectable sentinel node, and the concordance between static imaging and probe-based detection of sentinel node. Phase I Five patients were included, and a median of 30 (IQR 25-46) lymph nodes was resected. A median of 6 (IQR 2-9) retained lymph nodes was found in the esophagectomy specimen. No acute adverse events occurred, but near the end of lymphadenectomy esophageal discoloration was observed, possibly indicating ischemia. Phase II In all five included patients sentinel nodes could be visualized and resected, at a median of 3 (IQR 2-5) locations. There was a high concordance between imaging and probe-based detection of sentinel nodes. In conclusion, sentinel node navigation surgery followed by lymphadenectomy without concomitant esophagectomy seems feasible in patients with high-risk submucosal early esophageal adenocarcinoma. More evidence is however needed before applying this technique in clinical practice.
Asunto(s)
Palabras clave

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Neoplasias Esofágicas / Adenocarcinoma / Laparoscopía / Procedimientos Quirúrgicos Torácicos / Ganglio Linfático Centinela / Escisión del Ganglio Linfático Tipo de estudio: Evaluation_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Dis Esophagus Asunto de la revista: GASTROENTEROLOGIA Año: 2017 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Neoplasias Esofágicas / Adenocarcinoma / Laparoscopía / Procedimientos Quirúrgicos Torácicos / Ganglio Linfático Centinela / Escisión del Ganglio Linfático Tipo de estudio: Evaluation_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Dis Esophagus Asunto de la revista: GASTROENTEROLOGIA Año: 2017 Tipo del documento: Article