Park Jun Seok, Choi Gyu-Seog, Kim Hye Jin, Park Soo Yeon, Park Yun Jung, Lee Sang-Woo, Xu Ziguang, Bae Han Ik
Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
J Korean Soc Coloproctol. 2011 Apr;27(2):83-9. doi: 10.3393/jksc.2011.27.2.83. Epub 2011 Apr 30.
The purpose of this research was to evaluate the feasibility of sentinel lymph node (SLN) mapping involving transanal injection with an ex-vivo mapping in patients with rectal cancer.
Between April 2007 and December 2009, 20 consecutive patients with T1-3, N0-1 clinical stage rectal cancer preoperatively underwent a SLN procedure using submucosal (99m)Tc-phytate injection. All the patients underwent a total mesorectal excision. After the standard surgical resection, all specimens were identified on lymphoscintigraphy, and bench work was done to pick up the sentinel node basin. All the lymph nodes (non-SLNs and SLNs) were examined using conventional hematoxylin and eosin staining and immunohistochemistry with anti-cytokeratin antibodies.
SLNs were identified from 19 of 20 patients with rectal cancer. The total number of sentinel nodes retrieved from the surgical specimens was 29, and the mean number per patient was 1.6 (range, 0 to 4). In three patients, the SLN was the only positive lymph node. There was one false-negative case with a sensitivity of 88.8% and two upstaged cases (20.0%). The SLN samples from rectal cancer are mainly localized in the pararectal region, but aberrant nodes receive direct drainage from the rectal cancer. On planar lymphoscintigraphy, 15.7% of all patients had aberrant lymphatic drainage to the sigmoid mesenteric or sigmoid lymph node station.
In conclusion, the intraoperative transanal injection for ex-vivo SLN navigation is a safe, feasible surgical modality in patients with rectal cancer. Large studies are warranted to determine the clinical significance of the SLN concept and micrometastasis in rectal cancer.
本研究旨在评估经肛门注射联合体外定位法进行前哨淋巴结（SLN）定位在直肠癌患者中的可行性。
2007年4月至2009年12月期间，20例临床分期为T1 - 3、N0 - 1的直肠癌患者术前接受了经黏膜下注射（99m）锝 - 植酸盐的SLN手术。所有患者均接受了全直肠系膜切除术。标准手术切除后，对所有标本进行淋巴闪烁显像定位，并在实验台上找出前哨淋巴结区域。所有淋巴结（非前哨淋巴结和前哨淋巴结）均采用常规苏木精 - 伊红染色及抗细胞角蛋白抗体免疫组化进行检查。
20例直肠癌患者中有19例成功识别出前哨淋巴结。手术标本中获取的前哨淋巴结总数为29个，平均每位患者1.6个（范围为0至4个）。3例患者中，前哨淋巴结是唯一的阳性淋巴结。有1例假阴性病例，敏感性为88.8%，2例分期上调病例（20.0%）。直肠癌的前哨淋巴结样本主要位于直肠旁区域，但异常淋巴结直接引流直肠癌的淋巴液。在平面淋巴闪烁显像中，15.7%的患者存在异常淋巴引流至乙状结肠系膜或乙状结肠淋巴结区域。
总之，术中经肛门注射联合体外前哨淋巴结导航对直肠癌患者是一种安全、可行的手术方式。需要开展大规模研究以确定前哨淋巴结概念及微转移在直肠癌中的临床意义。
