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Carnoy solution versus GEWF solution for lymph node revealing in colorectal cancer: a randomized controlled trial

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Abstract

Purpose

This study aimed to compare the performance of two lymph node revealing solutions.

Methods

This randomized clinical trial (NTC02704988) investigated patients with colon or rectal cancer who underwent surgical resection with D2 lymphadenectomy. Specimens submitted for conventional pathological examination were randomly assigned for additional fixation with Carnoy or GEWF solution, and dissection was performed to examine the missed lymph nodes. The number of lymph nodes retrieved, additional identified metastatic lymph nodes, lymph node upstaging, and complementary indication of adjuvant therapy were investigated.

Results

The number of lymph nodes retrieved was significantly higher with the use of lymph node revealing solutions than with the conventional method in colon cancer (GEWF: 29.5 vs 27; p < 0.001; Carnoy: 27.7 vs 25.2; p < 0.001) and rectal cancer (GEWF: 25.8 vs 23.6; p < 0.001; Carnoy: 23.1 vs 20.8; p < 0.001). There were no differences between the solutions and conventional examination with respect to the median number of additional metastatic lymph nodes identified (0 in all arms), the number of patients with lymph node upstaging (colon cancer: 1 in the Carnoy arm, 0 in the GEWF arm; rectal cancer: 1 in the GEWF arm, 0 in the Carnoy arm), or the number of patients with complementary indication of adjuvant therapy (colon cancer: 1 in the Carnoy arm, 0 in the GEWF arm; rectal cancer: 0 in both arms).

Conclusion

Despite the higher number of lymph nodes retrieved, neither solution resulted in significant changes in patient staging or treatment. Both solutions exhibited equal performance with respect to all outcomes.

Trial registration

NTC02704988

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Fig. 1

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Acknowledgments

The authors thank Daniela Benzano Bumaguin for her help in the statistical analysis and Maria Francisca Torres Lopes and Márcio Machado for the pathological examination of surgical specimens.

Author information

Authors and Affiliations

  1. Division of Coloproctology, Hospital Moinhos de Vento, 2350 Ramiro Barcelos St, 600, Porto Alegre, RS, 90035-903, Brazil

    Tiago L. Ghezzi

  2. Division of Coloproctology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil

    Tiago L. Ghezzi

  3. Post-graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil

    Tiago L. Ghezzi & Antonio N. Kalil

  4. Anatpat Surgical Pathology Lab, Porto Alegre, Brazil

    Márcia P. Pereira

  5. Division of General Surgery, Department of Surgery, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Oly C. Corleta

Authors
  1. Tiago L. Ghezzi
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  2. Márcia P. Pereira
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  3. Oly C. Corleta
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  4. Antonio N. Kalil
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Contributions

Tiago L. Ghezzi: study conception and design, acquisition and interpretation of data, statistical analysis, manuscript writing, critical revision, final approval, and agreement to be accountable for all aspects of the work; Márcia P. Pereira: study conception and design, acquisition and interpretation of data, critical revision, final approval, and agreement to be accountable for all aspects of the work; Oly C. Corleta: study conception and design, acquisition and interpretation of data, critical revision, final approval, and agreement to be accountable for all aspects of the work; Antonio N. Kalil: study conception and design, acquisition and interpretation of data, manuscript writing, critical revision, final approval, and agreement to be accountable for all aspects of the work.

Corresponding author

Correspondence to Tiago L. Ghezzi.

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Ghezzi, T.L., Pereira, M.P., Corleta, O.C. et al. Carnoy solution versus GEWF solution for lymph node revealing in colorectal cancer: a randomized controlled trial. Int J Colorectal Dis 34, 2189–2193 (2019). https://doi.org/10.1007/s00384-019-03437-5

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  • DOI: https://doi.org/10.1007/s00384-019-03437-5

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