Use Carbon Nanoparticles to Show Decision-making Lymph Nodes around Inferior Mesenteric Artery in Rectal Cancer

Jun Yan, MD¹, Fangqin Xue², Wenju Liu³, Zhangyuanzhu Liu¹, Kai Li¹, Dexin Chen¹, Wei Jiang¹. ¹Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China, ²Department of Surgery, Fujian Provincial Hospital, Fuzhou,China, ³Department of Surgery, Fujian Provincial Tumor Hospital, Fuzhou,China

Objective: Identification of whether lymph nodes around inferior mesenteric artery have metastasis is very helpful for decision making of D2 or D3 lymph nodes dissection in rectal cancer. The purpose of this study was to evaluate the feasibility of using carbon nanoparticles to show decision-making lymph nodes around inferior mesenteric artery in rectal cancer.

Methods: Sixty patients with rectal cancer identified by pre-op colonoscopy were recruited. One milliliter carbon nanoparticles suspension was endoscopically injected into the submucosal layer at four points around the site of the primary tumor one day before surgery. Laparoscopic radical resection with D3 lymphadenectomy was performed. Decision-making lymph nodes were defined as nodes that were black-dyed by carbon nanoparticles around inferior mesenteric artery between left colic artery and abdominal aorta. Pathology confirmed consistency between decision-making lymph nodes and all D3 lymph nodes.

Results: Decision-making lymph nodes black-dyed by carbon nanoparticles were easily found under laparoscopy. The median number of decision-making lymph nodes was 2 (range = 1–4). All patients had decision-making lymph nodes lying alongside inferior mesenteric artery between left colic artery and abdominal aorta. After pathological analysis, 3 patients (5%) had lymph node metastasis in 60 patients with rectal cancer. In three cases with lymph node metastasis, decision-making lymph nodes were positive with 100% accuracy. In pathology, carbon nanoparticles were seen in lymphatic vessels, and lymphoid sinus and macrophages in lymph nodes.

Conclusions: It is feasible to use carbon nanoparticles to show decision-making lymph nodes around inferior mesenteric artery in rectal cancer.

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

Abstract ID: 84476

Program Number: ETP737

Presentation Session: Emerging Technology Poster

Presentation Type: Poster