Department of Thoracic Surgery, University of Health Sciences, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey.
Pınarbaşı Mah. Sanatoryum Cad, Ankara Atatürk Sanatoryum Eğitim ve Araştırma Hastanesi, B Blok 2. Kat Göğüs Cerrahisi Kliniği, 06280, Keçiören, Ankara, Turkey.
Updates Surg. 2024 Jan;76(1):299-303. doi: 10.1007/s13304-023-01624-2. Epub 2023 Aug 9.
Oxidized regenerated cellulose (ORC) is commonly used to control small intraoperative bleedings in lung cancer surgery. However, difficulties in its absorption may lead to complications that can mimic malignancy recurrence in the affected areas, and may require further examination.
Between 2015 and 2022, patients who underwent malignant tumour resection and lymph node dissection and were subsequently evaluated for suspected lymph node recurrence and underwent EBUS-guided needle biopsy were included in the study. Pathology reports of these patients showed an ORC-related foreign body type granulomatous reaction. Such reactions, caused by delayed absorption of ORC, can mimic malignancy recurrence and result in unnecessary biopsies.
In a total of 13 patients (10 males), pathology was observed in 18 lymph node areas after malignant resection and lymph node dissection, and ORC was detected in subcarinal and inferior paratracheal lymph node areas in all patients. The average age of the patients was calculated as 63.1 years (range 51-74). The mean SUVmax value observed in these lymph node areas on PET/CT was 5.22 (range 0-14.36). Although the SUVmax value decreased as the time between surgery and EBUS increased, no statistically significant difference was observed (p = 0.100).
The study suggests that in cases of suspected unexpected lymph node recurrence in postoperative follow-up of lung cancer, it is important for clinicians to communicate with the surgeon and re-evaluate the use of ORC by reviewing the operative notes. This may help in determining an appropriate further investigation strategy.
氧化再生纤维素（ORC）常用于控制肺癌手术中的小术中出血。然而，其吸收困难可能导致并发症，这些并发症可能模仿受影响区域的恶性肿瘤复发，并可能需要进一步检查。
在 2015 年至 2022 年期间，纳入了接受恶性肿瘤切除和淋巴结清扫术，随后因疑似淋巴结复发而行 EBUS 引导下针吸活检的患者。这些患者的病理报告显示存在与 ORC 相关的异物型肉芽肿反应。这种由 ORC 吸收延迟引起的反应可能模仿恶性肿瘤复发，并导致不必要的活检。
在总共 13 例（10 例男性）患者中，在恶性切除和淋巴结清扫后观察到 18 个淋巴结区域存在病理变化，并且所有患者的隆突下和下气管旁淋巴结区域均检测到 ORC。患者的平均年龄计算为 63.1 岁（范围 51-74 岁）。这些淋巴结区域在 PET/CT 上观察到的平均 SUVmax 值为 5.22（范围 0-14.36）。尽管 SUVmax 值随着手术与 EBUS 之间的时间增加而降低，但无统计学差异（p=0.100）。
该研究表明，在肺癌术后随访中怀疑出现意外淋巴结复发时，临床医生与外科医生进行沟通并通过查阅手术记录重新评估 ORC 的使用非常重要。这有助于确定适当的进一步调查策略。
