Borowski D W, Banky B, Banerjee A K, Agarwal A K, Tabaqchali M A, Garg D K, Hobday C, Hegab M, Gill T S
Department of Colorectal Surgery, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Stockton-on-Tees, UK.
Colorectal Dis. 2014 Sep;16(9):681-9. doi: 10.1111/codi.12681.
A randomized controlled trial was carried out to study the effect of a recently proposed technique of ex vivo intra-arterial methylene blue injection of the surgical specimen removed for colorectal cancer on lymph node harvest and staging.
Between May 2012 and February 2013, 100 consecutive colorectal cancer resection specimens in a single institution were randomly assigned to intervention (methylene blue injection) and control (standard manual palpation technique) groups before formalin fixation. The specimen was then examined by the histopathologist for lymph nodes.
Both groups were similar for age, sex, site of tumour, operation and tumour stage. In the intervention group, a higher number of nodes was found [median 23 (5-92) vs. 15 (5-37), P < 0.001], with only one specimen not achieving the recommended minimum standard of 12 nodes [1/50 (2%) vs. 8/50 (16%), P = 0.014]. However, there was no upstaging effect in the intervention group [23/50 (46.0%) vs. 20/50 (40.0%); P = 0.686]. With a significantly lower number of nodes harvested in rectal cancer, the positive effect of the intervention was particularly observed in the patients who underwent preoperative neoadjuvant radiotherapy [median 30 nodes (12-57) vs. 11 (7-15); P = 0.011; proportion of cases with < 12 nodes 0/5 vs. 5/8 (62.5%), P = 0.024].
Ex vivo intra-arterial methylene blue injection increases lymph node yield and can help to reduce the number of cases with a lower-than-recommended number of nodes, particularly in patients with rectal cancer having neoadjuvant treatment. The technique is easy to perform, cheap and saves time.
开展一项随机对照试验，以研究最近提出的对因结直肠癌切除的手术标本进行离体动脉内注射亚甲蓝技术对淋巴结采集及分期的影响。
2012年5月至2013年2月期间，在单一机构中，100例连续的结直肠癌切除标本在福尔马林固定前被随机分配至干预组（亚甲蓝注射）和对照组（标准手动触诊技术）。然后，病理学家对标本进行淋巴结检查。
两组在年龄、性别、肿瘤部位、手术及肿瘤分期方面相似。在干预组中，发现的淋巴结数量更多[中位数23（5 - 92）个对15（5 - 37）个，P < 0.001]，只有1份标本未达到推荐的至少12个淋巴结的最低标准[1/50（2%）对8/50（16%），P = 0.014]。然而，干预组没有上调分期的效果[23/50（46.0%）对20/50（40.0%）；P = 0.686]。由于直肠癌采集的淋巴结数量明显较少，干预的积极效果在接受术前新辅助放疗的患者中尤为明显[中位数30个淋巴结（12 - 57）个对11个（7 - 15）个；P = 0.011；淋巴结少于12个的病例比例0/5对5/8（62.5%），P = 0.024]。
离体动脉内注射亚甲蓝可增加淋巴结产量，并有助于减少淋巴结数量低于推荐数量的病例数，特别是在接受新辅助治疗的直肠癌患者中。该技术操作简便、成本低廉且节省时间。
