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01-08-2009 | Gastrointestinal Oncology

Sentinel Node Biopsy for the Individualization of Surgical Strategy for Cure of Early-Stage Colon Cancer

Authors: Ronan A. Cahill, MD, FRCS, Andreas Bembenek, MD, Saad Sirop, MD, Deirdre F. Waterhouse, MD, Wolfgang Schneider, MD, Joel Leroy, MD, David Wiese, MD, PhD, Thomas Beutler, MD, Anton Bilchik, MD, FACS, Sukamal Saha, MD, FACS, FRCS (C), Peter M. Schlag, MD

Published in: Annals of Surgical Oncology | Issue 8/2009

Abstract

Introduction

The requirement for nodal analysis currently confounds the oncological propriety of focused purely endoscopic resection for early-stage colon cancer and complicates the evolution of innovative alternatives such as natural orifice transluminal endoscopic surgery (NOTES) and its hybrids. Adjunctive sentinel node biopsy (SNB) deserves consideration as a means of addressing this shortfall.

Methods

Data from two prospectively maintained databases established for multicentric studies of SNB in colon cancer that employed similar methodologies were pooled to establish technique potency selectively in T1/T2 disease (both overall and under optimized conditions) and to project potential clinical impact.

Results

Of 891 patients with T1–4, M0 intraperitoneal colon cancer, 225 had T1/T2 disease. Sentinel nodes were either not found or were falsely negative in 18 patients with T1/T2 cancers (8%) as compared with 17% (112/646) in those with T3/T4 disease (P = 0.001). Negative predictive value (NPV) in the former exceeded 95%, while sensitivity [including immunohistochemistry (IHC)] was 81%. In the 193 patients with T1/T2 disease recruited from those centers contributing >22 patients, sensitivity was 89% and NPV 97%. Thus, in this cohort, SNB could have correctly prompted localized resection (obviating en bloc mesenteric dissection) in 75% (144) of patients, including 59 with T1 lesions potentially amenable to intraluminal resection alone as their definitive treatment. Forty-four patients (23.4%) would still have conventional resection, leaving three patients (1.6% overall) understaged (11% false-negative rate).

Conclusion

These findings support the further investigation of SNB as oncological augment for localized resective techniques. Specific prospective study should pursue this goal.

Tamegai Y, Saito Y, Masaki N, Hinohara C, Oshima T, Kogure E, et al. Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy. 2007;39:418–22.PubMedCrossRef

Hurlstone DP, Atkinson R, Sanders DS, Thomson M, Cross SS, Brown S. Achieving R0 resection in the colorectum using endoscopic submucosal dissection. Br J Surg. 2007;94:1536–42.PubMedCrossRef

Leroy J, Cahill RA, Forgione A, Perretta S, Dallemagne B, Marescaux J. Sigmoid colectomy by Natural Orifice Transluminal Endoscopic Surgery (NOTES): An experimental model with survival. Surg Endosc. 2009;1:24–30.CrossRef

Leroy J, Cahill R, Asakuma M, Dallemagne B, Marescaux J. Single port sigmoidectomy as definitive surgical treatment for prior diverticular disease in a human patient. Arch Surg. 2009;144:173–9.PubMedCrossRef

Fazio L, Cotterchio M, Manno M, McLaughlin J, Gallinger S. Association between colonic screening, subject characteristics and stage of colorectal cancer. Am J Gastroenterol. 2005;100:2531–9.PubMedCrossRef

Pignone M, Rich M, Teutsch SM, Berg AO, Lohr KN. Screening for colorectal cancer in adults at average risk: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2002;137:132–41.PubMed

Cahill RA, Lindesy I, Cunningham C. NOTES and colorectal cancer. Surgery through the looking glass. Gut. 2009 (In press).

Chok KS, Law WL. Prognostic factors affecting survival and recurrence of patients with pT1 and pT2 colorectal cancer. World J Surg. 2007;31:1485–90.PubMedCrossRef

Sakuragi M, Togashi K, Konishi F, et al. Predictive factors for lymph node metastasis in T1 stage colorectal carcinomas. Dis Colon Rectum. 2003;46:1626–32.PubMedCrossRef

10.

Yasuda K, Inomata M, Shiromizu A, Shiraishi N, Higashi H, Kitano S. Risk factors for occult lymph node metastasis of colorectal cancer invading the submucosa and indications for endoscopic mucosal resection. Dis Colon Rectum. 2007;50:1370–6.PubMedCrossRef

11.

Kitagawa Y, Kitajima M. Endoscopic treatment combined with laparoscopic sentinel node mapping for superficial gastrointestinal cancers. Endoscopy. 2007;39:471–5.PubMedCrossRef

12.

Saikawa Y, Otani Y, Kitagawa Y, et al. Interim results of sentinel node biopsy during laparoscopic gastrectomy: possible role in function-preserving surgery for early cancer. World J Surg. 2006;30:1962–8.PubMedCrossRef

13.

Kitagawa Y, Fujii H, Kumai K, et al. Recent advances in sentinel node navigation for gastric cancer: a paradigm shift of surgical management. J Surg Oncol. 2005;90:147–51.PubMedCrossRef

14.

Bianchi PP, Ceriani C, Rottoli M, et al. Laparoscopic lymphatic mapping and sentinel node detection in colon cancer. Surg Endosc. 2007;21:1567–71.PubMedCrossRef

15.

Wood TF, Saha S, Morton DL, et al. Validation of lymphatic mapping in colorectal cancer. In vivo, ex vivo and laparoscopic techniques. Ann Surg Oncol. 2001;8:150–7.PubMedCrossRef

16.

Cahill RA, Perretta S, Leroy J, Dallemagne B, Marescaux J. Sentinel node mapping in the sigmoid mesocolon by N.O.T.E.S. Ann Surg Oncol. 2008;15:2677–83.PubMedCrossRef

17.

Cahill RA, Leroy J, Marescaux J. Could sentinel node biopsy provide the oncological propriety for endoscopic resection of early stage colon cancer? BMC Surg. 2008;8:17.PubMedCrossRef

18.

Bembenek AE, Rosenberg R, Wagler E, et al. Sentinel lymph node biopsy in colon cancer: a prospective multicenter trial. Ann Surg. 2007;245:858–63.PubMedCrossRef

19.

Saha S, Seghal R, Patel M, et al. A multicenter trial of sentinel lymph node mapping in colorectal cancer: prognostic implications for nodal staging and recurrence. Am J Surg. 2006;191:305–10.PubMedCrossRef

20.

Cahill RA, Walsh D, Landers RJ, Watson RGK. Preoperative profiling of symptomatic breast cancer by diagnostic core biopsy. Ann Surg Oncol. 2006;13:45–51.PubMedCrossRef

21.

Smith FM, Coffey JC, El Sayeed A, O’Sullivan F, Kirwan WO, Redmond HP. Sentinel lymph node mapping in colorectal cancer. Br J Surg. 2003;90:1165–6.

22.

Hunerbein M, Totkas S, Ghadimi BM, Schlag PM. Preoperative evaluation of colorectal neoplasms by colonoscopic miniprobe ultrasonography. Ann Surg. 2000;232:46–50.PubMedCrossRef

23.

Mönig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer. Ann Surg Oncol. 1999;6:579–81.PubMedCrossRef

24.

Herrera-Ornelas L, Justiniano J, Castillo N, Petrelli NJ, Stulc JP, Mittelman A. Metastases in small lymph nodes from colon cancer. Arch Surg. 1987;122:1253–6.PubMed

25.

Herrera L, Villarreal JR. Incidence of metastases from rectal adenocarcinoma in small lymph nodes detected by a clearing technique. Dis Colon Rectum. 1992;35:783–8.PubMedCrossRef

26.

Rodriguez-Bigas MA, Maamoun S, et al. Clinical significance of colorectal cancer: metastases in lymph nodes <5 mm in size. Ann Surg Oncol. 1996;3:124–30.PubMedCrossRef

27.

Haboubi NY, Abdalla SA, Amini S, et al. The novel combination of fat clearance and immunohistochemistry improves prediction of the outcome of patients with colorectal carcinomas: a preliminary study. Int J Colorectal Dis. 1998;13:99–102.PubMedCrossRef

28.

Bergmann U, Beger HG. Endoscopic mucosal resection for advanced non-polypoid colorectal adenoma and early stage carcinoma. Surg Endosc. 2003;17:475–9.PubMedCrossRef

29.

Sticca RP. Is there clinical value to sentinel lymph node sampling in colon cancer? J Clin Oncol. 2006;24:841–2.PubMedCrossRef

30.

Pocard M, Van den Eynde M, Goere D, Boige V, Malka D. Sentinel lymph node sampling and analysis in colon cancer: what is the question? J Clin Oncol. 2006;24:3712–3.PubMedCrossRef

31.

Ellis LM. A perspective on sentinel lymph node biopsy in colorectal cancer: the race between surgical technology and molecular oncology. Ann Surg Oncol. 2000;7:475–6.PubMedCrossRef

32.

Bilchik AJ, Nora DT. Lymphatic mapping of nodal micrometastasis in colon cancer: putting the cart before the horse? Ann Surg Oncol. 2002;9:529–31.PubMedCrossRef

33.

Bilchik A, Comptom C. Close collaboration between surgeon and pathologist is essential for accurate staging of early colon cancer. Ann Surg. 2007;245:864–6.PubMedCrossRef

34.

Bader FG, Roblick UJ, Oevermann E, Bruch HP, Schwandner O. Radical surgery for early colorectal cancer- anachronism or oncologic necessity. Int J Colorectal Dis. 2008;23:410–7.CrossRef

35.

Chen SL, Bilchik AJ. More extensive nodal dissection improves survival for stages I to III of colon cancer. Ann Surg. 2006;244:602– 10.PubMed

36.

Steele, GJ, Colorectal cancer. In: McKenna RJ, Murphy GP, editors. Cancer surgery, Philadelphia: Lippincott; 1994. p. 125–184.

37.

Joseph NE, Sigurdson ER, Hanlon AL, et al. Accuracy of determining nodal negativity in colorectal cancer on the basis of the number of nodes retrieved on resection. Ann Surg Oncol. 2003;10:213–8.PubMedCrossRef

38.

Cahill RA, Asakuma M, Perretta S, Leroy J, Dallemagne B, Marescaux J, et al. Supplementation of endoscopic submucosal dissection with sentinel node biopsy performed by natural orifice transluminal endoscopic surgery (with video). Gastros Endosc. 2009 (Epub ahead of print).

39.

Cahill RA, Perretta S, Forgione A, Leroy J, Dallemagne B, Marescaux J. Combined sentinel node biopsy and localized sigmoid resection entirely by natural orifice transluminal endoscopic surgery: A new challenge to the old paradigm. Dis Colon Rectum. 2009 (Epub ahead of print).

40.

Sakuragi M, Togashi K, Konishi F, et al. Predictive factors for lymph node metastasis in T1 stage colorectal carcinomas. Dis Colon Rectum. 2003;46:1626–32.PubMedCrossRef

41.

Busuttil RW, Foglia RP, Longmire WP Jr. Treatment of carcinoma of the sigmoid colon and upper rectum. A comparison of local segmental resection and left hemicolectomy. Arch Surg. 1977;112:920–3.PubMed

42.

Ho YH, Low D, Goh HS. Bowel function survey after segmental colorectal resections. Dis Colon Rectum. 1996;39:307–10.PubMedCrossRef

43.

Rouffet F, Hay JM, Vacher B, et al. Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial. French Association for Surgical Research. Dis Colon Rectum. 1994;37:651–9.PubMedCrossRef

44.

Brennan DJ, Moynagh M, Brannigan AE, Gleeson F, Rowland M, O’Connell PR. Routine mobilization of the splenic flexure is not necessary during anterior resection for rectal cancer. Dis Colon Rectum. 2007;50:302–7.PubMedCrossRef

45.

Sarli L, Cinieri FG, Pavlidis C, et al. Anorectal function problems after left hemicolectomy. J Laparoendosc Adv Surg Tech A. 2006;16:565–71.PubMedCrossRef

46.

Sarli L, Pavlidis C, Cinieri FG, et al. Prospective comparison of laparoscopic left hemicolectomy for colon cancer with laparoscopic left hemicolectomy for benign colorectal disease. World J Surg. 2006;30:446–52.PubMedCrossRef

47.

Feig BW, Curley S, Lucci A, et al. A caution regarding lymphatic mapping in patients with colon cancer. Am J Surg. 2001;182:707–12.PubMedCrossRef

48.

Redston M, Compton C, Miedea B, et al. Analysis of micrometastatic disease in sentinel lymph nodes from resectable colon cancer: results of cancer and leukemia Group B Trial 80001. J Clin Oncol. 2006;24:878–83.PubMedCrossRef

49.

Lim SJ, Feig BW, Wang H, et al. Sentinel lymph node evaluation does not improve staging accuracy in colon cancer. Ann Surg Oncol. 2008;15:46–51.PubMedCrossRef

50.

McMasters KM, Giuliano AE, Ross MI, et al. Sentinel-lymph-node biopsy for breast cancer–not yet the standard of care. N Engl J Med. 1998;339:990–5.PubMedCrossRef

51.

Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23:7703–20.PubMedCrossRef

52.

Edge SB, Hurd TC. Sentinel node update: breast cancer. Oncology. 1999;13:213–8.

53.

Balch CM, Cascinelli N. Sentinel-node biopsy in melanoma. New Engl J Med. 2006;355:1370–1.PubMedCrossRef

54.

55.

Wood TF, Nora DT, Morton DL, et al. One hundred consecutive cases of sentinel lymph node mapping in early colorectal carcinoma: detection of missed micrometastases. J Gastrointest Surg. 2002;6:322–9.PubMedCrossRef

56.

Bilchik AJ, Nora D, Tollenaar RA, et al. Ultrastaging of early colon cancer using lymphatic mapping and molecular analysis. Eur J Cancer. 2002;38:977–85.PubMedCrossRef

57.

Kitagawa Y, Watanabe M, Hasegawa H, et al. Sentinel node mapping for colorectal cancer with radioactive tracer. Dis Colon Rectum. 2002;45:1476–80.PubMedCrossRef

58.

Ratanachaikanont T, Karalak A. Sentinel node localization in breast cancer using intradermal dye injection: results, influencing factors and learning curve. J Med Assoc Thai. 2005;88:386–90.PubMed

59.

Viehl CT, Hamel CT, Marti WR, et al. Identification of sentinel lymph nodes in colon cancer depends on the amount of dye injected relative to tumor size. World J Surg. 2003;27:1285–90.PubMedCrossRef

60.

Bilchik AJ, Compton C. Close collaboration between surgeon and pathologist is essential for accurate staging of early colon cancer. Ann Surg. 2007;245:864–6.PubMedCrossRef

61.

Wood TF, Spirt M, Rangel D, et al. Lymphatic mapping improves staging during laparoscopic colectomy for cancer. Surg Endosc. 2001;15:715–9.PubMedCrossRef

62.

Chung MH, Ye W, Giuliano AE. Role for sentinel lymph node dissection in the management of large (> or = 5 cm) invasive breast cancer. Ann Surg Oncol. 2001;8:688–92.PubMed

63.

Nason KS, Anderson BO, Byrd DR, et al. Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma. Cancer. 2000;89:2187–94.PubMedCrossRef

64.

Cahill RA, Diamond L, Landers R, Walsh D, Watson RG. Validation of lymphatic mapping and sentinel node biopsy in patients with symptomatic breast cancer. Ir J Med Sci. 2006;175:59–62.PubMedCrossRef

65.

O’Hea BJ, Hill AD, El-Shirbiny AM, Yeh SD, Rosen PP, Coit DG, Borgen PI, Cody HS 3rd. Sentinel lymph node biopsy in breast cancer: initial experience at Memorial Sloan-Kettering Cancer Center. J Am Coll Surg. 1998;186:423–7.PubMedCrossRef

66.

Wong SL, Edwards MJ, Chao C, et al. Sentinel lymph node biopsy for breast cancer: impact of the number of sentinel nodes removed on the false-negative rate. J Am Coll Surg. 2001;192:684–9.PubMedCrossRef

67.

Dan AG, Saha S, Monson KM, et al. 1% lymphazurin vs 10% fluorescein for sentinel node mapping in colorectal tumors. Arch Surg. 2004;139:1180–4.PubMedCrossRef

68.

Cahill RA. NOTES- here and now. The Surgeon. 2009; (In press).

69.

Franklin ME Jr, Leyva-Alvizo A, Abrego-Medina D, Glass JL, Treviño J, Arellano PP, et al. Laparoscopically monitored colonoscopic polypectomy: an established form of endoluminal therapy for colorectal polyps. Surg Endosc. 2007;21:1650–3.PubMedCrossRef

70.

Winter H, Lang RA, Spelsberg FW, Jauch KW, Huttl TP. Laparoscopic colonoscopic rendezvous procedures for the treatment of polyps and early stage carcinomas of the colon. Int J Colorectal Dis. 2007;22:1377–81.PubMedCrossRef

71.

Blumencranz P, Whitworth PW, Deck K, et al. Sentinel node staging for breast cancer: intraoperative molecular pathology overcomes conventional histologic sampling errors. Am J Surg. 2007;194:426–32.PubMedCrossRef

72.

Goetz, Kiesslich R. Confocal endomicroscopy: in vivo diagnosis of neoplastic lesions of the gastrointestinal tract. Anticancer Res. 2008:28:353–60.PubMed

73.

Ababdasabapathy S. Endoscopic imaging emerging optical techniques for the detection of colorectal neoplasia. Curr Opin Gastroenterol. 2008;24:64–9.CrossRef

74.

Taylor JC, Kendall CA, Stone N, Cook TA. Optical adjuncts for enhanced colonoscopic diagnosis. Br J Surg. 2007;94:6–16.PubMedCrossRef

75.

Luo W, Nguyen FT, Zysk AM, et al. Optical biopsy of lymph node morphology using optical coherence tomography. Technol Cancer Res Treat. 2005;4:539–48.PubMed

76.

Kim JH, Cheon JH, Kim TI, et al. Effectiveness of radical surgery after incomplete mucosal resection for early colorectal cancers. Dig Dis Sci. 2008;53:2941–6.PubMedCrossRef

77.

Chok KS, Law WL. Prognostic factors affecting survival and recurrence of patients with pT1 and pT2 colorectal cancer. World J Surg. 2007;31:1485–90.PubMedCrossRef

78.

Wang HS, Liang WY, Lin TC, et al. Curative resection of T1 colorectal carcinoma: risk of lymph node metastasis and long-term prognosis. Dis Colon Rectum. 2005;48:1182–92.PubMedCrossRef

79.

Liefers GJ, Cleton-Jansen AM, van de Velde CJ, et al. Micrometastases and survival in stage II colorectal cancer. N Engl J Med. 1998;339:223–8.PubMedCrossRef

80.

Bilchik AJ, Hoon DS, Saha S, et al. Prognostic Impact of Micrometastases in Colon Cancer. Interim results of a prospective multicentre trial. Ann Surg. 2007;246:568–77.PubMedCrossRef

81.

Kitagawa Y, Watanabe M, Hasegawa H, et al. Sentinel node mapping for colorectal cancer with radioactive tracer. Dis Colon Rectum. 2002;45:1476–80.PubMedCrossRef

82.

Bilchik AJ, Saha S, Tsioulias GJ, Wood TF, Morton DL. Aberrant drainage and missed micrometastases: the value of lymphatic mapping and focused analysis of sentinel lymph nodes in gastrointestinal neoplasms. Ann Surg Oncol. 2001;8(9 Suppl):82S–85S.PubMed

Title: Sentinel Node Biopsy for the Individualization of Surgical Strategy for Cure of Early-Stage Colon Cancer
Authors: Ronan A. Cahill, MD, FRCS
Andreas Bembenek, MD
Saad Sirop, MD
Deirdre F. Waterhouse, MD
Wolfgang Schneider, MD
Joel Leroy, MD
David Wiese, MD, PhD
Thomas Beutler, MD
Anton Bilchik, MD, FACS
Sukamal Saha, MD, FACS, FRCS (C)
Peter M. Schlag, MD
Publication date: 01-08-2009
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 8/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-009-0510-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sentinel Node Biopsy for the Individualization of Surgical Strategy for Cure of Early-Stage Colon Cancer

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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