Wang Yi-Zarn, Carrasquillo Jean P, McCord Elizabeth, Vidrine Rhea, Lobo Monica L, Zamin S Ali, Boudreaux Philip, Woltering Eugene
Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA.
Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA.
Surgery. 2014 Dec;156(6):1498-502; discussion 1502-3. doi: 10.1016/j.surg.2014.05.028. Epub 2014 Nov 11.
We previously reported that midgut neuroendocrine tumors (NETs) often develop alternative lymphatic drainage owing to lymphatic obstructions from extensive mesenteric lymphadenopathy, making intraoperative lymphatic mapping mandatory. We hypothesize that this innovative approach needs a longer term validation.
We updated our results by reviewing 303 patients who underwent cytoreduction from November 2006 to October 2011. Of these patients, 112 had lymphatic mappings and 98 were for midgut NET primaries. Among them, 77 mappings were for the initial cytoreduction and 35 were for reexploration and further cytoreduction. The operative findings, pathology reports, and long-term surgical outcomes were reviewed.
Lymphatic mapping changed traditional resection margins in 92% of patients. Of the 35 patients who underwent reexploration without initial mapping, 19 (54%) showed a recurrence at or near the anastomotic sites. In contrast, none of the 112 mapped patients had shown signs of recurrence in a 1- to 5-year follow-up. Additionally, 20 of 45 ileocecal valves (44.4%) were spared in patients whose tumors were at the terminal ileum that, traditionally, would call for a right hemicolectomy.
With a longer follow-up, lymphatic mapping has proven to be a safe and effective way to prevent local recurrences and preserve the ileocecal valve for selected patients.
我们之前报道过，由于广泛的肠系膜淋巴结病导致淋巴管阻塞，中肠神经内分泌肿瘤（NETs）常出现替代性淋巴引流，因此术中淋巴管造影必不可少。我们推测这种创新方法需要更长期的验证。
我们通过回顾2006年11月至2011年10月接受减瘤手术的303例患者的结果进行了更新。在这些患者中，112例进行了淋巴管造影，98例为中肠NET原发肿瘤。其中，77例造影用于初次减瘤手术，35例用于再次探查和进一步减瘤手术。对手术结果、病理报告和长期手术结局进行了回顾。
淋巴管造影在92%的患者中改变了传统的切除边界。在35例未进行初次造影就接受再次探查的患者中，19例（54%）在吻合口处或其附近出现复发。相比之下，在1至5年的随访中，112例进行了造影的患者均未出现复发迹象。此外，在肿瘤位于回肠末端的患者中，45个回盲瓣中有20个（44.4%）得以保留，而按照传统做法这些患者需要进行右半结肠切除术。
随着随访时间延长，淋巴管造影已被证明是一种安全有效的方法，可预防局部复发并为特定患者保留回盲瓣。
