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Efficacy of fat dissolution fluid containing collagenase and lipase for lymph node retrieval after laparoscopic lymph node dissection for colorectal cancer

Michiya Kobayashi, Hiromichi Maeda, Ken Okamoto, Tsutomu Namikawa, Kazuhiro Hanazaki. Kochi Medical School

Introduction: Lymph node (LN) retrieval after surgery is important. In the present study we evaluated the efficacy of the fat dissolution technique using fluid containing collagenase and lipase to avoid staging migration after laparoscopic colorectal surgery.

Methods: Seventeen patients who underwent laparoscopic LN dissection for colorectal cancer were evaluated. First, unfixed LNs within the resected mesentery were explored by visual inspection and palpation immediately after the operation by the surgeon, which is the most common practice in Japan. Subsequently, the fat dissolution technique was used on remnant fat tissue, and the LNs were evaluated again. The primary endpoint was whether the second assessment increased the number of LNs evaluated.

Results: The median number of LNs identified at the first and second assessments was 14 and 6, respectively, resulting in a significant increase in the total number of LNs evaluated (14 vs. 21, P<0.01, paired t-test). One positive node was identified among all the additional LNs identified (1.0%; 1/96). Although staging was not altered in any patient, the second assessment resulted in an increase in the originally insufficient number of LNs evaluated (<12 for Stage II) in three patients, whose treatment may be altered. Tumor cells detected after the fat dissolution technique were stained with carcinoembryonic antigen and cytokeratin-20.

Conclusion: Using the fat dissolution liquid on remnant fat tissue of the mesentery of the colon and rectum enabled identification of additional LNs. This method should be considered when the number of LNs identified is not sufficient after conventional LN retrieval, and may avoid stage migration.


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

Abstract ID: 86152

Program Number: P250

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

39

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