[Lymphatic mapping and sentinel lymph node biopsy in selected carcinomas of the digestive tract]

The current status of lymphatic mapping and sentinel node biopsy in patients with selected carcinomas of the digestive tract is described. The possible future use of the method in patients with gastric, small bowel and colorectal malignancies is considered. Preoperative lymphatic mapping and reliable identification of sentinel node (nodes) in patients with gastrointestinal cancers may lead to tailored resections or limited surgical procedures. On the other hand, extended lymph node dissection may be performed in those patients in whom the sentinel node(s) contains tumour cells or in cases where skip lymphatic nodes metastases appear. The method offers the opportunity of improving staging (ultrastaging) by identification of patients with early dissemination in lymphatic nodes where conventional methods are not sensitive enough. These patients should be considered for traditional adjuvant treatment or be included in trials with more effective adjuvants regimens. Large prospective multicenter studies are needed to find out if the sentinel node concept is valid in gastrointestinal cancer. If the answer is yes, several basic diagnostic and therapeutic measures may be changed in favour of cancer patients.