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Sentinel node biopsy for the individualization of surgical strategy for cure of early-stage colon cancer

Item Type:Article
Title:Sentinel node biopsy for the individualization of surgical strategy for cure of early-stage colon cancer
Creators Name:Cahill, R.A., Bembenek, A., Sirop, S., Waterhouse, D.F., Schneider, W., Leroy, J., Wiese, D., Beutler, T., Bilchik, A., Saha, S. and Schlag, P.M.
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.
Keywords:Colonic Neoplasms, Lymph Nodes, Neoplasm Staging, Prognosis, Prospective Studies, Sentinel Lymph Node Biopsy
Source:Annals of Surgical Oncology
Page Range:2170-2180
Date:August 2009
Official Publication:https://doi.org/10.1245/s10434-009-0510-9
PubMed:View item in PubMed

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