Nucleotide-guided Mesorectal Excision (NGME) Combined with Endoluminal Locoregional Resection (ELRR) By Tem in the Treatment of Rectal Tumours: Technique and Preliminary Results.

Emanuele Lezoche, MD, Bernardina Fabiani, MD, Giancarlo D’Ambrosio, MD, Pietro Ursi, MD, Andrea Balla, MD, Giovanni Lezoche, MD, Francesco Monteleone, MD, Alessandro M. Paganini, MD, PhD

Department of General Surgery, ‘P. Stefanini’, Policlinico Umberto I, Sapienza University of Rome

Aim: Endoluminal Loco-Regional Resection (ELRR) by Transanal Endoscopic Microsurgery (TEM) is an alternative treatment option in T1N0 rectal cancer and in selected patients with small T2N0 rectal cancer after neoadjuvant radiochemotherapy (n-RCT). However, the N parameter may remain undefined after transanal surgery. Aim is to evaluate the role of a modified sentinel lymph node technique to improve N staging, named by the authors “Nucleotide-Guided Mesorectal Excision” (NGME).

Methods and procedures: 41 patients (24 males and 17 females, mean age 70.5 years) were enrolled. Preoperative staging was: dysplasia with no suspicion for cancer at imaging (8), dysplasia with suspected malignancy at imaging (15), no suspicion of malignancy at imaging after n-RCT (2), cT1N0 (6), cT2N0 (6), cT3N0 (3), cT3N1 (1). All patients underwent ELRR by TEM with NGME. 99m-Technetium-marked nanocolloid was injected in the peritumoral submucosa before surgery. After specimen removal, the residual perirectal fat was probed to detect residual radioactivity. If present, hot mesorectal fat was excised.

Results: With NGME, the mesorectal lymph node harvest has increased from 0 up to 10. Lymph nodes were isolated in the specimen or in hot mesorectal fat in 20 patients, in 8 of whom after n-RCT. Mean lymph nodes harvest in irradiated and in non-irradiated patients was 2.75 ± 3.01 (range 1-10) and 2.91 ± 1.62 (range 1-6) (p= 0.87), respectively. The average lymph nodes number in irradiated patients was higher than in a previous historical series (unpublished data).

Conclusions: NGME during ELRR by TEM increases the lymph node harvest and it may improve the staging accuracy of loco-regional resection.

Session: Poster Presentation

Program Number: P131

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