The Feasibility of an Ex-vivo Sentinel Lymph Mapping Using Preoperative Radioisotope Injection in Cases of Extraperitoneal Rectal Cancer.
10.3393/jksc.2011.27.2.83
- Author:
Jun Seok PARK
1
;
Gyu Seog CHOI
;
Hye Jin KIM
;
Soo Yeon PARK
;
Yun Jung PARK
;
Sang Woo LEE
;
Ziguang XU
;
Han Ik BAE
Author Information
1. Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea. kyuschoi@mail.knu.ac.kr
- Publication Type:Original Article
- Keywords:
Rectal neoplasms;
Transanal injection;
Sentinel lymph node;
Lymphoscintigraphy
- MeSH:
Colon, Sigmoid;
Drainage;
Eosine Yellowish-(YS);
Hematoxylin;
Humans;
Immunohistochemistry;
Lymph Nodes;
Lymphoscintigraphy;
Neoplasm Micrometastasis;
Nitriles;
Pyrethrins;
Rectal Neoplasms
- From:Journal of the Korean Society of Coloproctology
2011;27(2):83-89
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The purpose of this research was to evaluate the feasibility of sentinel lymph node (SLN) mapping involving transanal injection with an ex-vivo mapping in patients with rectal cancer. METHODS: Between April 2007 and December 2009, 20 consecutive patients with T1-3, N0-1 clinical stage rectal cancer preoperatively underwent a SLN procedure using submucosal 99mTc-phytate injection. All the patients underwent a total mesorectal excision. After the standard surgical resection, all specimens were identified on lymphoscintigraphy, and bench work was done to pick up the sentinel node basin. All the lymph nodes (non-SLNs and SLNs) were examined using conventional hematoxylin and eosin staining and immunohistochemistry with anti-cytokeratin antibodies. RESULTS: SLNs were identified from 19 of 20 patients with rectal cancer. The total number of sentinel nodes retrieved from the surgical specimens was 29, and the mean number per patient was 1.6 (range, 0 to 4). In three patients, the SLN was the only positive lymph node. There was one false-negative case with a sensitivity of 88.8% and two upstaged cases (20.0%). The SLN samples from rectal cancer are mainly localized in the pararectal region, but aberrant nodes receive direct drainage from the rectal cancer. On planar lymphoscintigraphy, 15.7% of all patients had aberrant lymphatic drainage to the sigmoid mesenteric or sigmoid lymph node station. CONCLUSION: In conclusion, the intraoperative transanal injection for ex-vivo SLN navigation is a safe, feasible surgical modality in patients with rectal cancer. Large studies are warranted to determine the clinical significance of the SLN concept and micrometastasis in rectal cancer.
