Abstract. Background In patients with colorectal cancer (CRC), the accurate establishment of the pathological status of tumor-draining mesenteric lymph nodes (LN) is of central importance for therapeutic management. In patients with stage III disease with demonstrated LN metastases, adjuvant systemic chemotherapy is indicated, reducing the risk of recurrence and improving long-term overall survival (1). The accuracy of mesenteric nodal staging depends primarily on the number of resected LN, and the seventh American Joint Committee on Cancer (AJCC) edition recommends harvesting and analysis of at least 12 to 14 LN for correct staging (2). Despite this, 20-30% of patients with no LN metastases demonstrated at pathology (pN0), and therefore classified as stage II, still develop recurrent disease (3). These recurrences could potentially be associated with unrecognized locoregional nodal metastases, which could lead to understaging and undertreatment.The sentinel lymph node (SLN) is defined as the first LN draining the primary tumor. In melanoma and breast cancer, it has been shown that pathological status of the SLN is indicative of the risk of nodal metastases, thus providing an indication for lymphadenectomy when SLN pathological examination is positive and for avoiding mutilating surgery when it is negative (4, 5). The concept, and potential utility, of the SLN is different in CRC since mesenteric lymphadenectomy is systematically performed during surgery for the primary tumor. In patients with CRC, the particular contribution of SLN examination could be to focus the pathological analysis specifically on draining LNs in order to improve the sensitivity for cancer cell detection by the use of advanced methods, such as serial sectioning, immunohistochemistry (IHC), and molecular analyses such as reverse transcriptase polymerase chain reaction (RT-PCR) to increase pathological staging (6).Accordingly, a recent meta-analysis concluded that the use of SLN examination allowed for nodal up-staging of patients with CRC, providing a potential benefit (7). However, the technique of SLN analysis is still not widely used in patients with CRC. This could be related to the variability of the sensitivity of techniques for SLN detection which ranges from 33% to 100%, to the risk of missed metastases, and also to uncertainty related to the clinical significance and prognostic value of nodal micrometastases in CRC (7-9).Recently, fluorescence imaging (FI) using indocyanine green (ICG) has emerged as a new technique for SLN detection in various tumors (10)(11)(12). Only few studies have 4853

In our experience, both salvage esophagectomy and esophagectomy after pRCT showed good survival results with low postoperative morbidity and mortality. Salvage surgery remains a therapeutic indication in selected patients. J. Surg. Oncol. 2016;114:833-837. © 2016 2016 Wiley Periodicals, Inc.

Synopsis: Defecatory problems may occur after low anterior resection with total mesorectal excision. This study evaluated the incidence of these problems and their impact on quality of life in patients who underwent surgery for mid or low rectal cancer.

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