Clinical Aspect: Esophageal Cancer

  • Yoshikazu UenosonoEmail author
  • Takaaki Arigami
  • Shigehiro Yanagita
  • Itaru Omoto
  • Ken Sasaki
  • Yasuto Uchikado
  • Shoji Natsugoe


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.


Sentinel node Esophageal cancer Lymph node metastasis Micrometastasis Minimally invasive surgery 


  1. 1.
    Akutsu Y, Kato K, Igaki H, Ito Y, Nozaki I, Daiko H, Yano M, Udagawa H, Nakagawa S, Takagi M, et al. The prevalence of overall and initial lymph node metastases in clinical T1N0 thoracic esophageal cancer: from the results of JCOG0502, a prospective multicenter study. Ann Surg. 2016;264(6):1009–15.PubMedCrossRefGoogle Scholar
  2. 2.
    Lerut T, Nafteux P, Moons J, Coosemans W, Decker G, De Leyn P, Van Raemdonck D, Ectors N. Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections: impact on staging, disease-free survival, and outcome: a plea for adaptation of TNM classification in upper-half esophageal carcinoma. Ann Surg. 2004;240(6):962–72. discussion 972–964PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Igaki H, Tachimori Y, Kato H. Improved survival for patients with upper and/or middle mediastinal lymph node metastasis of squamous cell carcinoma of the lower thoracic esophagus treated with 3-field dissection. Ann Surg. 2004;239(4):483–90.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Natsugoe S, Matsumoto M, Okumura H, Uchikado Y, Setoyama T, Sasaki K, Sakurai T, Omoto I, Owaki T, Shinchi H, et al. Clinical course and outcome after esophagectomy with three-field lymphadenectomy in esophageal cancer. Langenbeck's Arch Surg. 2010;395(4):341–6.CrossRefGoogle Scholar
  5. 5.
    Dimick JB, Pronovost PJ, Cowan JA Jr, Lipsett PA, Stanley JC, Upchurch GR Jr. Variation in postoperative complication rates after high-risk surgery in the United States. Surgery. 2003;134(4):534–40. discussion 540–531PubMedCrossRefGoogle Scholar
  6. 6.
    Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, Foshag LJ, Cochran AJ. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Kitagawa Y, Takeuchi H, Takagi Y, Natsugoe S, Terashima M, Murakami N, Fujimura T, Tsujimoto H, Hayashi H, Yoshimizu N, et al. Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol. 2013;31(29):3704–10.PubMedCrossRefGoogle Scholar
  8. 8.
    Kitagawa Y, Fujii H, Mukai M, Kubota T, Ando N, Watanabe M, Ohgami M, Otani Y, Ozawa S, Hasegawa H, et al. The role of the sentinel lymph node in gastrointestinal cancer. Surg Clin North Am. 2000;80(6):1799–809.PubMedCrossRefGoogle Scholar
  9. 9.
    Kato H, Miyazaki T, Nakajima M, Takita J, Sohda M, Fukai Y, Masuda N, Fukuchi M, Manda R, Ojima H, et al. Sentinel lymph nodes with technetium-99m colloidal rhenium sulfide in patients with esophageal carcinoma. Cancer. 2003;98(5):932–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Yasuda S, Shimada H, Chino O, Tanaka H, Kenmochi T, Takechi M, Nabeshima K, Okamoto Y, Kato Y, Kijima H, et al. Sentinel lymph node detection with Tc-99m tin colloids in patients with esophagogastric cancer. Jpn J Clin Oncol. 2003;33(2):68–72.PubMedCrossRefGoogle Scholar
  11. 11.
    Lamb PJ, Griffin SM, Burt AD, Lloyd J, Karat D, Hayes N. Sentinel node biopsy to evaluate the metastatic dissemination of oesophageal adenocarcinoma. Br J Surg. 2005;92(1):60–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Takeuchi H, Fujii H, Ando N, Ozawa S, Saikawa Y, Suda K, Oyama T, Mukai M, Nakahara T, Kubo A, et al. Validation study of radio-guided sentinel lymph node navigation in esophageal cancer. Ann Surg. 2009;249(5):757–63.PubMedCrossRefGoogle Scholar
  13. 13.
    Thompson SK, Bartholomeusz D, Devitt PG, Lamb PJ, Ruszkiewicz AR, Jamieson GG. Feasibility study of sentinel lymph node biopsy in esophageal cancer with conservative lymphadenectomy. Surg Endosc. 2011;25(3):817–25.PubMedCrossRefGoogle Scholar
  14. 14.
    Kim HK, Kim S, Park JJ, Jeong JM, Mok YJ, Choi YH. Sentinel node identification using technetium-99m neomannosyl human serum albumin in esophageal cancer. Ann Thorac Surg. 2011;91(5):1517–22.PubMedCrossRefGoogle Scholar
  15. 15.
    Uenosono Y, Arigami T, Yanagita S, Kozono T, Arima H, Hirata M, Kita Y, Uchikado Y, Okumura H, Matsumoto M, et al. Sentinel node navigation surgery is acceptable for clinical T1 and N0 esophageal cancer. Ann Surg Oncol. 2011;18(7):2003–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Burian M, Stein HJ, Sendler A, Piert M, Nahrig J, Feith M, Siewert JR. Sentinel node detection in Barrett's and cardia cancer. Ann Surg Oncol. 2004;11(3 Suppl):255S–8S.PubMedCrossRefGoogle Scholar
  17. 17.
    Yuasa Y, Seike J, Yoshida T, Takechi H, Yamai H, Yamamoto Y, Furukita Y, Goto M, Minato T, Nishino T, et al. Sentinel lymph node biopsy using intraoperative indocyanine green fluorescence imaging navigated with preoperative CT lymphography for superficial esophageal cancer. Ann Surg Oncol. 2012;19(2):486–93.PubMedCrossRefGoogle Scholar
  18. 18.
    Hachey KJ, Gilmore DM, Armstrong KW, Harris SE, Hornick JL, Colson YL, Wee JO. Safety and feasibility of near-infrared image-guided lymphatic mapping of regional lymph nodes in esophageal cancer. J Thorac Cardiovasc Surg. 2016;152(2):546–54.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Matsuda T, Takeuchi H, Tsuwano S, Nakahara T, Mukai M, Kitagawa Y. Sentinel node mapping in adenocarcinoma of the esophagogastric junction. World J Surg. 2014;38(9):2337–44.PubMedCrossRefGoogle Scholar
  20. 20.
    Grotenhuis BA, Wijnhoven BP, van Marion R, van Dekken H, Hop WC, Tilanus HW, van Lanschot JJ, van Eijck CH. The sentinel node concept in adenocarcinomas of the distal esophagus and gastroesophageal junction. J Thorac Cardiovasc Surg. 2009;138(3):608–12.PubMedCrossRefGoogle Scholar
  21. 21.
    Kubota K, Yoshida M, Kuroda J, Okada A, Ohta K, Kitajima M. Application of the HyperEye Medical System for esophageal cancer surgery: a preliminary report. Surg Today. 2013;43(2):215–20.PubMedCrossRefGoogle Scholar
  22. 22.
    Tsai JA, Celebioglu F, Lindblad M, Lorinc E, Nilsson M, Olsson A, Lundell L, Axelsson R. Hybrid SPECT/CT imaging of sentinel nodes in esophageal cancer: first results. Acta Radiol. 2013;54(4):369–73.PubMedCrossRefGoogle Scholar
  23. 23.
    Nagaraja V, Eslick GD, Cox MR. Sentinel lymph node in oesophageal cancer-a systematic review and meta-analysis. J Gastrointest Oncol. 2014;5(2):127–41.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Boone J, Hobbelink MG, Schipper ME, Vleggaar FP, Borel Rinkes IH, de Haas RJ, Ruurda JP, van Hillegersberg R. Sentinel node biopsy during thoracolaparoscopic esophagectomy for advanced esophageal cancer. World J Surg Oncol. 2016;14:117.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Arima H, Natsugoe S, Uenosono Y, Arigami T, Ehi K, Yanagita S, Higashi H, Ishigami S, Hokita S, Aikou T. Area of nodal metastasis and radioisotope uptake in sentinel nodes of upper gastrointestinal cancer. J Surg Res. 2006;135(2):250–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Yanagita S, Natsugoe S, Uenosono Y, Kozono T, Ehi K, Arigami T, Arima H, Ishigami S, Aikou T. Sentinel node micrometastases have high proliferative potential in gastric cancer. J Surg Res. 2008;145(2):238–43.PubMedCrossRefGoogle Scholar
  27. 27.
    Hagihara T, Uenosono Y, Arigami T, Kozono T, Arima H, Yanagita S, Hirata M, Ehi K, Okumura H, Matsumoto M, et al. Assessment of sentinel node concept in esophageal cancer based on lymph node micrometastasis. Ann Surg Oncol. 2013;20(9):3031–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Sato Y, Kosugi S, Aizawa N, Ishikawa T, Kano Y, Ichikawa H, Hanyu T, Hirashima K, Bamba T, Wakai T. Risk factors and clinical outcomes of recurrent laryngeal nerve paralysis after esophagectomy for thoracic esophageal carcinoma. World J Surg. 2016;40(1):129–36.PubMedCrossRefGoogle Scholar
  29. 29.
    Kato H, Sato A, Fukuda H, Kagami Y, Udagawa H, Togo A, Ando N, Tanaka O, Shinoda M, Yamana H, et al. A phase II trial of chemoradiotherapy for stage I esophageal squamous cell carcinoma: Japan Clinical Oncology Group Study (JCOG9708). Jpn J Clin Oncol. 2009;39(10):638–43.PubMedCrossRefGoogle Scholar
  30. 30.
    Takeuchi H, Kawakubo H, Nakamura R, Fukuda K, Takahashi T, Wada N, Kitagawa Y. Clinical significance of sentinel node positivity in patients with superficial esophageal cancer. World J Surg. 2015;39(12):2941–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Yoshikazu Uenosono
    • 1
    Email author
  • Takaaki Arigami
    • 1
    • 2
  • Shigehiro Yanagita
    • 2
  • Itaru Omoto
    • 2
  • Ken Sasaki
    • 2
  • Yasuto Uchikado
    • 2
  • Shoji Natsugoe
    • 1
    • 2
  1. 1.Molecular Frontier SurgeryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
  2. 2.Department of Digestive Surgery, Breast and Thyroid SurgeryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan

Personalised recommendations