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Title: Minimally invasive sentinel lymph node biopsy in oesophageal adenocarcinoma
Author: Wahed, Shajahan
ISNI:       0000 0004 6346 8583
Awarding Body: University of Newcastle upon Tyne
Current Institution: University of Newcastle upon Tyne
Date of Award: 2016
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Introduction and Aims Sentinel lymph nodes are the first nodes draining a primary tumour and the most likely sites of early metastases. A minimally invasive technique of identifying sentinel nodes in oesophageal adenocarcinoma could revolutionise management by determining whether patients with submucosal disease can be treated solely by endoscopic resection and whether other patients are suitable for a less radical lymphadenectomy. We evaluated a laparoscopic technique of identifying abdominal sentinel lymph nodes in patients with oesophageal adenocarcinoma and assessed whether these nodes could predict overall lymph node status. Methods This trial recruited patients with lower-third oesophageal adenocarcinoma planned for two-stage oesophagectomy with two-field lymphadenectomy. Sentinel node identification occurred immediately before resection, following endoscopic submucosal injection of 99mTechnetium-nanocol!oid. A laparoscopic gamma probe measured radioactivity from all nodal stations at laparoscopy, from the open abdomen, from the mediastinum following thoracotomy and ex vivo following removal of the specimen. Sentinel nodes had in vivo radioactivity greater than twice and ex vivo greater than 10 times background. Specimens were examined using haematoxylin and eosin and immunohistochemistry. Results A total of 1297 lymph nodes were examined from 40 patients (median 31 nodes). The median age and BMI were 65.5years and 26.5kg/m2 re s pectively. The overall sentinel node detection rate was 85% and sensitivity 88%. The laparoscopic abdominal sentinel node detection rate was 58% (23/40). Lymph node metastases were identified in 13 of these 23 patients, in whom laparoscopic abdominal sentinel nodes were positive in 10 but negative in three (sensitivity 77%). Two of these negative patients had mediastinal sentinel node micrometastases. Eleven patients had only mediastinal sentinel nodes. Five patients had no sentinel nodes. Adhesions prevented laparoscopy in one patient. Conclusions Laparoscopic identification of abdominal sentinel lymph using 99mTechnetium in patients with oesophageal adenocarcinoma was safe and technically feasible but not sensitive enough to predict overall nodal status.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available