[Current status and future perspectives of sentinel node navigation surgery for esophageal cancer]

Esophageal cancer is a particularly aggressive malignancy because of the high incidence and widespread distribution of lymph node metastases. However, the sentinel node (SN) concept appears to be applicable even for esophageal cancer, according to recent reports. A dye-guided method is not applicable for esophageal cancer because of its anatomic site. It is impossible to trace the flow of blue dye within a certain observation time without destruction of the lymphatic network. SNs in esophageal cancer are multiple and their distribution is widely spread from the cervical to the abdominal area. Therefore the lymphoscintigram in the radio-guided method is essential to identify the SNs in esophageal cancer. Recently chemoradiotherapy has attracted attention as a multidisciplinary curative treatment for cT1N0 esophageal cancer. In this approach, control of invisible micrometases is essential. Lymphoscintigrams revealing the distribution of SNs in each individual case are useful to plan the field of irradiation. Selective and modified lymphadenectomy for clinical N0 esophageal cancer should become feasible and clinically useful. Individualized selective lymphadenectomy for cN0 esophageal cancer located in the esophagogastric junction including Barrett's carcinoma based on SN status would be a reasonable surgical approach.