Hubert J. Stein, Maria Burian, Marcus Feith, Morand Piert, Jorg Naehrig, J. Ruediger Siewert, Chirurgische Klinik und Poliklinik TU Muenchen, Munich, Germany, Department of Nuclear Medicine TU Munich, Munich, Germany, Department of Pathology TU Munich, Munich, Germany

Background: Extended lymphadenectomy may improve the prognosis in patients with adenocarcinoma of the esophagogastric junction (AEG) but also adds to the morbidity of the surgical resection. Prediction of lymphatic spread could thus be helpful to tailor the extent of surgical resection. We report our first experience with sentinel lymph node identification in AEG tumors. Material and Methods: Intra-operative sentinel node identification was attempted in 35 patients who had resection for an AEG tumor (26 T1-tumors, 9 T2/T3-tumors). All patients had preoperative endoscopic peritumoral injection of a technetium colloid with intraoperative sentinel node identification by a hand held gamma probe, 24/35 patients also had an intraoperative peritumoral injection of lymphazurine blue dye and visual idenfication of the first blue stained lymph nodes. All identified 'sentinel nodes' were removed and assessd separately for tumor spread with standard histological and immunohistochemical techniques. Results: One or more sentinel nodes (median 2) could be identified in 32/35 patients with the technetium technique and in 20/24 patients with blue dye injection. The location of the sentinel node(s) varied markedly among the patients. The identified sentinel node(s) correctly predicted the lymph node status in 91% of the patients with T1 tumors and 83% of the patients with T2/T3 tumors. Conclusion: Sentinel lymphadenectomy appears to be feasible and valid in patients with early adenocarcinoma of the esophagogastric junction. This opens the door for tailored lymphadenectomy strategies and reduction of the aggressiveness of the surgical approach.