Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510-515, People's Republic of China.
Surg Endosc. 2019 Mar;33(3):904-910. doi: 10.1007/s00464-018-6384-9. Epub 2018 Aug 16.
Accurate identification of lymph nodes localized around inferior mesenteric artery (IMA), with or without metastasis, is of crucial importance for surgeons when dissecting D2 or D3 lymph nodes in patients with rectal cancer (RC). The following study evaluates whether carbon nanoparticles can be used for detection of decision-making lymph nodes (DLNs) in station 253 lymph nodes found around IMA during RC surgery.
A total of 66 patients with rectal adenocarcinomas were recruited between January 2014 and August 2017. Patients were divided into carbon nanoparticle (CN) group and control (CL) group; for the CN group, 1 ml nanoparticles were endoscopically injected into submucosal layer of primary tumor 1 day before surgery. DLNs were defined as black-dyed nodes in CN group or macroscopic lymph nodes in CL group localized along the IMA, proximal to the origin of the left colic artery. D3 lymph nodes were dissected using laparoscopic radical resection, and then examined using pathological approach. Intra-operative and post-operative data were compared between the two groups.
In CN group, black-dyed DLNs were easily found under laparoscopy; the median number of DLNs was 3 (range 1-9). In CL group, the median number of DLNs was 0 (range 0-3). Consistency between intra-operative DLNs and post-operative station 253 nodes were confirmed by pathological examination. Significant higher number of DLNs in station 253 nodes (2.91 ± 2.47 vs 0.58 ± 0.75, p < 0.001), number of station 251 nodes (12.85 ± 8.99 vs 8.09 ± 5.85, p = 0.014), number of station 253 nodes (5.21 ± 5.26 vs 3.15 ± 2.32, p = 0.045), and the number of total lymph nodes (24.06 ± 13.20 vs 16.21 ± 9.09, p = 0.007) were found in the CN group compared to CL group.
Carbon nanoparticles are useful for identifying DLNs in station 253 LNs around IMA in RC. It is not necessary to perform D3 lymph node dissection if there are no intra-operative DLNs metastases in RC.
在直肠腺癌患者的 D2 或 D3 淋巴结清扫术中，准确识别肠系膜下动脉（IMA）周围有或无转移的淋巴结至关重要。本研究评估了在直肠癌手术中，碳纳米粒子是否可用于检测 IMA 周围 253 站淋巴结中的决策性淋巴结（DLNs）。
2014 年 1 月至 2017 年 8 月期间，共招募了 66 例直肠腺癌患者。患者分为碳纳米粒子（CN）组和对照组（CL）；CN 组在术前 1 天，内镜下将 1ml 纳米粒子注入原发性肿瘤黏膜下层。CN 组中，DLNs 定义为沿 IMA 、距左结肠动脉起源近端处发现的黑色染色淋巴结；CL 组中，DLNs 定义为宏观淋巴结。使用腹腔镜根治性切除术对 D3 淋巴结进行解剖，然后采用病理方法进行检查。比较两组患者的术中及术后数据。
在 CN 组中，腹腔镜下很容易发现黑色染色的 DLNs；DLNs 的中位数为 3 个（范围 1-9 个）。CL 组中，DLNs 的中位数为 0 个（范围 0-3 个）。术中 DLNs 与术后 253 站淋巴结的一致性通过病理检查得到证实。253 站淋巴结的 DLNs 数量明显较多（2.91±2.47 比 0.58±0.75，p<0.001），251 站淋巴结数量较多（12.85±8.99 比 8.09±5.85，p=0.014），253 站淋巴结数量较多（5.21±5.26 比 3.15±2.32，p=0.045），总淋巴结数量较多（24.06±13.20 比 16.21±9.09，p=0.007）。
碳纳米粒子可用于识别直肠癌 IMA 周围 253 站淋巴结中的 DLNs。如果术中没有 DLNs 转移，则无需进行 D3 淋巴结清扫。
