[Sentinel node navigation surgery in esophageal cancer]

If the sentinel node (SN) concept is established in esophageal cancer, SN navigation surgery (SNNS) will be clinically useful. Individualized treatment will become possible, such as fewer lymphadenectomies in the upper mediastinal and cervical regions, SN sampling with endoscopic therapy, and targeted radiotherapy for SNs. Since the dye method is difficult to use for SN detection because of the complicated lymphatic flow in the esophagus and anthoracosis in the lymph nodes, the radioisotope method is used in esophageal cancer. When SNNS is introduced clinically, accurate diagnosis of nodal metastases, including micrometastases, will be essential. At present, there are few reports on the SN concept in esophageal cancer, and sufficient clinical evidence has not yet accumulated. In our experience, the detection rate was 93% in clinical NO patients with superficial esophageal cancer, and the accuracy rate was 100% for nodal metastases, including micrometastases. A clinical trial of SNNS has started in elderly patients with preoperative complications and in poor-risk patients. In the near future, a multicenter trial will be necessary to establish a standard for individualized therapy.