The sentinel lymph node (SLN) procedure in rectal cancer was studied according to the following parameters: identifi cation rate, accuracy, sensitivity, false-negative rate, and upstaging percentages. The analyzed studies reported a large variation of nodal identifi cation rates with overall high false-negative rates (ie, the percentage of rectal cancer patients in whom the SLN did not correctly represent the tumor status of the lymph node basin). These results are likely due to the anatomic localization of the rectum and disturbed lymphatic drainage after preoperative radiotherapy with or without concurrent chemotherapy. Therefore, the SLN procedure does not appear to be technically feasible in rectal cancer, and full lymphatic staging (as part of total mesorectal excision) should remain the standard for patient care.
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