Quadros Claudio Almeida, Lopes Ademar, Araújo Iguaracyra, Fahel Fernanda, Bacellar Melina Silva, Dias Cristiano Souza
Colorectal, Pathology and Nuclear Medicine Divisions, Aristides Maltez Cancer Hospital, Av. D. João VI, 332, Brotas, 40285-001, Salvador, Bahia, Brazil.
Ann Surg Oncol. 2006 Dec;13(12):1617-21. doi: 10.1245/s10434-006-9116-7. Epub 2006 Sep 29.
Total mesorectal excision (TME) is the standard surgical choice for rectal adenocarcinoma. Better prognostic results, achieved with a retroperitoneal and lateral pelvic lymphadenectomy (RLPL), have questioned that TME might not be satisfactory for adequate patient staging, affecting therapeutic definitions. The aims of the ongoing study are to define the accuracy of dye and probe search in the detection of metastatic retroperitoneal and lateral pelvic nodes (RLPN) resected with RLPL, and to evaluate the metastasis frequency in these nodes and its eventual upstaging impact.
Thirty rectal adenocarcinoma patients were submitted to RLPL, with RLPN mapping using technetium (Tc 99 m) and patent blue, having nodes examined histopathologically and immunohistochemically.
Eight hundred and two nodes were analyzed, mean of 26.7 per patient; RLPL was responsible for 41% (330) of the examined nodes, mean of 11 per patient. Metastatic RLPN have occurred in 20% of the patients; the RLPN were metastatic in only 6.7% of the patients; RLPL upstaged 13.3%. For identification of metastatic RLPN with technetium, sensitivity was 33%, specificity 79%, positive predictor value (PPV) 29%, negative predictor value (NPV) 83% and false negative (FN) rate 67%. For patent blue and technetium metastatic RLPN identification, sensitivity was 17%, specificity 92%, PPV 33%, NPV 82% and FN 83%.
Preliminary results have pointed out technetium and blue dye low accuracy to identify metastatic RLPN; no metastatic RLPN were reported in the patients submitted to preoperative chemoradiation and important upstaging with RLPL. Considering no increase in morbi-mortality rates with RLPL, definitive conclusions will be obtained as the study carries on.
全直肠系膜切除术（TME）是直肠腺癌的标准手术选择。腹膜后和侧盆腔淋巴结清扫术（RLPL）取得了更好的预后结果，这对TME在充分的患者分期方面可能并不令人满意提出了质疑，从而影响治疗方案的确定。本研究的目的是确定用染料和探针检测经RLPL切除的腹膜后和侧盆腔转移淋巴结（RLPN）的准确性，并评估这些淋巴结中的转移频率及其最终的分期上调影响。
30例直肠腺癌患者接受RLPL，使用锝（Tc 99 m）和专利蓝进行RLPN定位，对淋巴结进行组织病理学和免疫组织化学检查。
共分析了802个淋巴结，平均每位患者26.7个；RLPL涉及41%（330个）的检查淋巴结，平均每位患者11个。20%的患者发生了RLPN转移；仅6.7%的患者RLPN有转移；RLPL使分期上调了13.3%。用锝识别转移RLPN时，敏感性为33%，特异性为79%，阳性预测值（PPV）为29%，阴性预测值（NPV）为83%，假阴性（FN）率为67%。对于用专利蓝和锝识别转移RLPN，敏感性为17%，特异性为92%，PPV为33%，NPV为82%，FN为83%。
初步结果指出锝和蓝色染料识别转移RLPN的准确性较低；术前接受放化疗的患者未报告有转移RLPN，且RLPL使分期显著上调。考虑到RLPL不会增加病死发生率，随着研究的继续将得出明确结论。
