Kocher H M, Sohail M, Benjamin I S, Patel A G
Department of Surgery, King's College Hospital, London, UK.
Eur J Surg Oncol. 2007 Sep;33(7):887-91. doi: 10.1016/j.ejso.2007.02.037. Epub 2007 Apr 12.
The high incidence of lymphatic and peri-neural invasion in pancreatic cancer results in poor loco-regional control. Radical pancreatico-duodenectomy may achieve better loco-regional control, but is accompanied by increasing morbidity. Our hypothesis was that if intra-operative mapping of pathological lymph nodes (LN) is technically feasible in pancreatic cancer, it would allow for selective radical resection.
In an ethically approved and statistically powered feasibility study of 72 (stopped after 20% enrollment) patients with suspected pancreatic cancer undergoing resection, we injected methylene blue dye peri- and intra-tumorally and studied its progress to identify putative 'sentinel lymph node(s)'. The Kausch-Whipple procedure (or total pancreatectomy, if required) was carried out in addition to radical LN dissection, which was evaluated histopathologically according to the Japanese criteria.
Over 18 months, 14/16 patients prospectively recruited underwent lymph node mapping and a mean of 20 (range 11-37) LNs per patient were harvested. Methylene blue dye injection identified blue LN(s) in 4/14 patients, none of which were positive for malignant deposits, whilst 10/14 patients had LN metastases. The commonest stations for LN metastasis were 17A or B (9/10), 8A (2/10) and 6 (3/10). The median survival for the 13 patients with cancer was 22.3 months (IQR: 10.4-30 months).
Sentinel lymph node mapping is not technically feasible in pancreatic cancer.
胰腺癌中淋巴管和神经周围侵犯的高发生率导致局部区域控制不佳。根治性胰十二指肠切除术可能实现更好的局部区域控制，但会伴随着发病率的增加。我们的假设是，如果术中对胰腺癌的病理淋巴结（LN）进行定位在技术上可行，那么就可以进行选择性根治性切除。
在一项经伦理批准且具有统计学效力的可行性研究中，对72例（入组20%后停止）疑似胰腺癌且接受切除术的患者，我们在肿瘤周围和肿瘤内注射亚甲蓝染料，并研究其进展以识别假定的“前哨淋巴结”。除了根治性淋巴结清扫外，还进行了考施-惠普尔手术（或必要时的全胰切除术），并根据日本标准对其进行组织病理学评估。
在18个月的时间里，前瞻性招募的14/16例患者接受了淋巴结定位，每位患者平均采集了20个（范围11 - 37个）淋巴结。亚甲蓝染料注射在4/14例患者中识别出蓝色淋巴结，其中无一例有恶性沉积物阳性，而10/14例患者有淋巴结转移。淋巴结转移最常见的部位是17A或B（9/10）、8A（2/10）和6（3/10）。13例癌症患者的中位生存期为22.3个月（四分位间距：10.4 - 30个月）。
前哨淋巴结定位在胰腺癌中技术上不可行。
