腹腔镜结肠癌切除术中前哨淋巴结活检及淋巴绘图技术

Technique of sentinel lymph node biopsy and lymphatic mapping during laparoscopic colon resection for cancer.

作者信息

Bianchi Pp, Andreoni B, Rottoli M, Celotti S, Chiappa A, Montorsi M

机构信息

Department of General and Laparoscopic Surgery, European Institute of Oncology IRCCS.

出版信息

Ecancermedicalscience. 2007;1:60. doi: 10.3332/ecancer.2008.60. Epub 2007 Nov 15.

DOI:10.3332/ecancer.2008.60

PMID:22275957

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3223971/

Abstract

BACKGROUND

The utility of lymph node mapping to improve staging in colon cancer is still under evaluation. Laparoscopic colectomy for colon cancer has been validated in multi-centric trials. This study assessed the feasibility and technical aspects of lymph node mapping in laparoscopic colectomy for colon cancer.

METHODS

A total of 42 patients with histologically proven colon cancer were studied from January 2006 to September 2007. Exclusion criteria were: advanced disease (clinical stage III), rectal cancer, previous colon resection and contraindication to laparoscopy. Lymph-nodal status was assessed preoperatively by computed tomography (CT) scan and intra-operatively with the aid of laparoscopic ultrasound. Before resection, 2-3 ml of Patent Blue V dye was injected sub-serosally around the tumour. Coloured lymph nodes were marked as sentinel (SN) with metal clips or suture and laparoscopic colectomy with lymphadenectomy completed as normal. In case of failure of the intra-operative procedure, an ex vivo SN biopsy was performed on the colectomy specimen after resection.

RESULTS

A total number of 904 lymph nodes were examined, with a median number of 22 lymph nodes harvested per patient. The SN detection rate was 100%, an ex vivo lymph node mapping was necessary in four patients. Eleven (26.2%) patients had lymph-nodal metastases and in five (45.5%) of these patients, SN was the only positive lymph node. There were two (18.2%) false-negative SN. In three cases (7.1%) with aberrant lymphatic drainage, lymphadenectomy was extended. The accuracy of SN mapping was 95.2% and negative predictive value was 93.9%.

CONCLUSIONS

Laparoscopic lymphatic mapping and SN removal is feasible in laparoscopic colectomy for colon cancer. The ex vivo technique is useful as a salvage technique in case of failure of the intra-operative procedure. Prospective studies are justified to determine the real accuracy and false-negative rate of the technique.

摘要

背景

淋巴结定位在改善结肠癌分期方面的效用仍在评估中。腹腔镜结肠癌切除术已在多中心试验中得到验证。本研究评估了腹腔镜结肠癌切除术中淋巴结定位的可行性和技术方面。

方法

2006年1月至2007年9月共研究了42例经组织学证实的结肠癌患者。排除标准为：晚期疾病（临床分期III期）、直肠癌、既往结肠切除术以及腹腔镜检查的禁忌症。术前通过计算机断层扫描（CT）评估淋巴结状态，并在术中借助腹腔镜超声进行评估。切除前，在肿瘤周围浆膜下注射2 - 3毫升专利蓝V染料。将染色的淋巴结用金属夹或缝线标记为前哨（SN），并按常规完成腹腔镜结肠癌切除术及淋巴结清扫。如果术中操作失败，在切除后对结肠切除标本进行体外前哨淋巴结活检。

结果

共检查了904个淋巴结，每位患者切除的淋巴结中位数为22个。前哨淋巴结检测率为100%，4例患者需要进行体外淋巴结定位。11例（26.2%）患者有淋巴结转移，其中5例（45.5%）患者中，前哨淋巴结是唯一的阳性淋巴结。有2例（18.2%）前哨淋巴结假阴性。3例（7.1%）存在异常淋巴引流的病例，扩大了淋巴结清扫范围。前哨淋巴结定位的准确率为95.2%，阴性预测值为93.9%。