Sentinel Lymph Node Procedure Leads to Upstaging of Patients with Resectable Colon Cancer: Results of the Swiss Prospective, Multicenter Study Sentinel Lymph Node Procedure in Colon Cancer

Carsten T. Viehl MD, Ulrich Guller MD, MHS, Ramona Cecini MD, Igor Langer MD, Alex Ochsner MD, Luigi Terracciano MD, Hans-Martin Riehle MD, Urban Laffer MD, FRCS, Daniel Oertli MD, FACS, FRCS, Markus Zuber MD
Colorectal Cancer
Volume 19, Issue 6 / June , 2012

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Abstract

Background

The value of the sentinel lymph node (SLN) procedure in colon cancer patients remains a matter of debate. The objective of this prospective, multicenter trial was 3-fold: to determine the identification rate and accuracy of the SLN procedure in patients with resectable colon cancer; to evaluate the learning curve of the SLN procedure; and to assess the extent of upstaging due to the SLN procedure.

Methods

One hundred seventy-four consecutive colon cancer patients were enrolled onto this prospective trial. They underwent an intraoperative SLN procedure with isosulfan blue 1% injected peritumorally followed by open standard colon resection with oncologic lymphadenectomy. Three levels of each SLN were stained with hematoxylin and eosin (H&E) and immunostained with the pancytokeratin marker AE1/AE3 if H&E was negative.

Results

SLN identification rate and accuracy were 89.1% and 83.9%, respectively. SLN were significantly more likely to contain tumor infiltrates than non-SLN (P < 0.001). Both SLN identification rate (P = 0.021) and the sensitivity of the procedure (P = 0.043) significantly improved with experience. The use of immunohistochemistry in SLN resulted in an upstaging of 15.4% (16 of 104) stage I and II patients considered node-negative in initial H&E analysis.

Conclusions

The SLN procedure for colon cancer has good identification and accuracy rates, which further improve with increasing experience. Most importantly, the SLN procedure results in upstaging of >15% of node-negative patients. The potential advantage of performing the SLN procedure appears to be particularly important in these patients because they may potentially benefit from adjuvant therapy.

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