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

Ronan A. Cahill, Andreas Bembenek, Saad Sirop, Deirdre F. Waterhouse, Wolfgang Schneider, Joel Leroy, David Wiese, Thomas Beutler, Anton Bilchik, Sukamal Saha, Peter M. Schlag

Research output: Contribution to journalArticlepeer-review

41 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2170-2180
Number of pages11
JournalAnnals of surgical oncology
Volume16
Issue number8
DOIs
StatePublished - Aug 2009

ASJC Scopus subject areas

  • Surgery
  • Oncology

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