Sentinel Lymph Node Mapping In Colorectal Cancer

摘要

Sentinel lymph node (SLN) mapping has been widely applied in the staging of solid neoplasms including colon and rectal cancer. Since the first reported feasibility study in 1997, there have been numerous publications validating SLN mapping as a highly accurate and powerful upstaging technique for colon and rectal cancer. In addition to refining the technical aspects of this procedure, these studies have investigated the use of other tracers and operative techniques, while determining the indications, limitations, and pitfalls of SLN mapping in patients with colorectal cancers. This chapter reviews the rationale for performing SLN mapping for the accurate staging of colon and rectal cancers, and provides a brief review of the historical background of the development of the procedure. We will focus on the technical details of the procedure, and on the pathological evaluation of the specimen and the SLNs. The various tracers and techniques of SLN mapping in colon and rectal cancer will be discussed. We have performed SLN mapping in more than 600 consecutive patients over the past 10 years. The success rates for identifying at least one SLN for colon and rectal cancer were 99.2 and 92%, respectively. The accuracy rates were 93.1 and 95.2%, respectively. In terms of upstaging, 24.2% of the colon cancer patients with nodal metastases and 25.9% of rectal patients with nodal metastases were upstaged by the detection of micrometastases found in the SLNs only.