Advertisement

International Journal of Colorectal Disease

, Volume 34, Issue 12, pp 2189–2193 | Cite as

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

  • Tiago L. GhezziEmail author
  • Márcia P. Pereira
  • Oly C. Corleta
  • Antonio N. Kalil
Short Communication
  • 36 Downloads

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

Keywords

Randomized controlled trial Colorectal cancer Lymph node Lymphadenectomy Lymph node revealing solution 

Notes

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 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.

References

  1. 1.
    Kotanagi H, Fukuoka T, Shibata Y, Yoshioka T, Aizawa O, Saito Y, Tur GE, Koyama K (1993) The size of regional lymph nodes does not correlate with the presence or absence of metastasis in lymph nodes in rectal cancer. J Surg Oncol 54:252–254CrossRefGoogle Scholar
  2. 2.
    Horne J, Carr NJ, Bateman AC, Kandala N II, Adams J, Silva S, Ryder I (2016) A comparison of formalin and GEWF in fixation of colorectal carcinoma specimens: rates of lymph node retrieval and effect on TNM staging. J Clin Pathol 69:511–517CrossRefGoogle Scholar
  3. 3.
    Horne J, Bateman AC, Carr NJ, Ryder I (2014) Lymph node revealing solutions in colorectal cancer: should they be used routinely? J Clin Pathol 67:383–388CrossRefGoogle Scholar
  4. 4.
    Dias AR, Pereira MA, de Mello ES, Nahas SC, Cecconello I, Jr R (2018) U. Lymph node yield after neoadjuvant chemoradiotherapy in rectal cancer specimens: a randomized trial comparing two fixatives. Dis Colon Rectum 6:886–896Google Scholar
  5. 5.
    Kim YM, Suh JH, Cha HJ, Jang SJ, Kim MJ, Yoon S, Kim B, Chang H, Kwon Y, Hong EK, Ro JY (2007) Additional lymph node examination from entire submission of residual mesenteric tissue in colorectal cancer specimens may not add clinical and pathologic relevance. Hum Pathol 38:762–767CrossRefGoogle Scholar
  6. 6.
    Haboubi NY, Clark P, Kaftan SM, Schofield PF (1992) The importance of combining xylene clearance and immunohistochemistry in the accurate staging of colorectal carcinoma. J R Soc Med 85:386–388PubMedPubMedCentralGoogle Scholar
  7. 7.
    Vogel C, Kirtil T, Oellig F, Stolte M (2008) Lymph node preparation in resected colorectal carcinoma specimens employing the acetone clearing method. Pathol Res Pract 204:11–15CrossRefGoogle Scholar
  8. 8.
    Scott KW, Grace RH (1989) Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 76:1165–1167CrossRefGoogle Scholar
  9. 9.
    Ustün MO, Onal B, Tuğyan N, Rezanko T (1999) Lymph node revealing solution: is it effective on detecting minute lymph nodes? Adv Clin Pathol 3:135–138Google Scholar
  10. 10.
    Saleki S, Haeri H (2002) Lymph node revealing solution: a prospective study on 35 patients with colorectal carcinomas. Acta Medica Iranica 40:223–225Google Scholar
  11. 11.
    Koren R, Siegal A, Klein B, Halpern M, Kyzer S, Veltman V, Gal R (1997) Lymph node-revealing solution: simple new method for detecting minute lymph nodes in colon carcinoma. Dis Colon Rectum 40:407–410CrossRefGoogle Scholar
  12. 12.
    Märkl B, Herbst C, Cacchi C et al (2015) Prognostic significance of histologically detected lymph node micrometastases of sizes between 0.2 and 2 mm in colorectal cancer. Int J Color Dis 28:977–983CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of ColoproctologyHospital Moinhos de VentoPorto AlegreBrazil
  2. 2.Division of ColoproctologyHospital de Clinicas de Porto AlegrePorto AlegreBrazil
  3. 3.Post-graduate Program in Health SciencesFederal University of Health Sciences of Porto AlegrePorto AlegreBrazil
  4. 4.Anatpat Surgical Pathology LabPorto AlegreBrazil
  5. 5.Division of General Surgery, Department of Surgery, Hospital de Clinicas de Porto AlegreFederal University of Rio Grande do SulPorto AlegreBrazil

Personalised recommendations