Sentinel lymph node in patients with rectal cancer invading the anal canal

To assess the feasibility of the sentinel lymph node procedure in patients with rectal cancer extending to the anal canal.

Between January 2005 and April 2008, 15 patients with adenocarcinoma of the rectum with direct invasion of the anal canal and no clinical evidence of inguinal involvement were prospectively enrolled in the study. The sentinel node procedure consisted of a combination of preoperative radiocolloid lymphoscintigraphy and intraoperative detection of the inguinal sentinel node with a gamma probe. Patent blue dye was also used to facilitate direct identification of the blue-stained lymph node. After removal, the sentinel node was studied by hematoxylin-eosin staining and immunohistochemistry.

Detection and removal of inguinal sentinel nodes was possible in all patients. Four patients (26.7%) had sentinel nodes identified as positive for metastatic adenocarcinoma. All positive cases also had metastases detected in perirectal lymph nodes; three of them developed hepatic or pulmonary metastases within 6 months after surgery. Of the 11 patients with negative sentinel nodes, only four (36.4%) also presented metastatic perirectal lymph nodes. Although none of the negative cases developed late inguinal metastases, three developed systemic or pelvic recurrence within 12 months after surgery.

The standardized procedure was highly effective in sampling inguinal sentinel nodes in very low rectal cancers, allowing the detection of subclinical metastatic disease. Although this technique can be potentially useful for a subgroup of patients with isolated inguinal metastases, it cannot be routinely recommended for patients with rectal tumors invading the anal canal at this moment.