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A Case-Control Study of Using Carbon Nanoparticles to Show Decision-making Lymph Nodes around Inferior Mesenteric Artery in Rectal Cancer

Kai Li, Dexin Chen, Zhangyuanzhu Liu, Weisheng Chen, Wei Jiang, Xiumin Liu, Ziming Cui, Jinbin Li, Cai Chen, Jun Yan. Department of General Surgery, Nanfang Hospital, Southern Medical University

Background: Identification of lymph nodes around inferior mesenteric artery (IMA) with or without metastasis will be very helpful to decision making of D2 or D3 lymph nodes dissection in rectal cancer. The aim of this study was to evaluate whether carbon nanoparticles were helpful to show decision-making lymph nodes (DLNs) in 253 lymph nodes around IMA in rectal cancer.

Methods: A case-control study was conducted between January 2014 and August 2017. The patients divided into carbon nanoparticle group and control group were matched with 1:1 manner by age, body mass index, gender, tumor location and neoadjuvant therapy. In carbon nanoparticle group, one milliliter injection of carbon nanoparticles was endoscopically injected into submucosal layer of primary tumor one day before surgery. DLNs were defined as nodes that black-dyed by carbon nanoparticles lie along the IMA proximal to the origin of the left colic artery. Laparoscopic radical resection with D3 lymphadenectomy was performed. DLNs received intra-operative frozen pathological examination. Intra-operative and post-operative data were compared between the two groups.

Results: Sixty-six patients with rectal cancer were selected. DLNs black-dyed by carbon nanoparticles were easily found under laparoscopy (Fig. 1C). The median number of DLNs was 3 (range: 1–9). Pathology confirmed consistency between intra-operative DLNs and post-operative 253 lymph nodes. When intra-operative DLNs were negative, no other positive 253 lymph nodes were found after surgery. As compared to control group, patients in carbon nanoparticle group has significant differences in number of DLNs of 253 lymph node harvested (2.91±2.47 vs 0.58±0.75, p<0.001), number of 251 lymph nodes harvested (12.85±8.99 vs 8.09±5.85, p=0.014), number of 253 lymph nodes harvested (5.21±5.26 vs 3.15±2.32, p=0.045), and the number of total lymph nodes harvested (24.06±13.20 vs 16.21±9.09, p=0.007).

Conclusions: Carbon nanoparticles were helpful to show DLNs in 253 lymph nodes around IMA in rectal cancer. It is not necessary to perform D3 lymph nodes dissection when intra-operative DLNs were no metastasis in rectal cancer.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87294

Program Number: S059

Presentation Session: Instrumentation / Devices / Technologies Session

Presentation Type: Podium

21

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