Skip to main content

Advertisement

SpringerLink
Log in

Ex Vivo Sentinel Lymph Node Study For Rectal Adenocarcinoma: Preliminary Study

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Intraoperative sentinel lymph node (SLN) detection has been reported for colon cancer, but no study has focused on rectal cancer. Only an ex vivo technique can be performed easily in this location. We evaluated SLN detection using blue dye injection in patients with rectal adenocarcinoma. This prospective study included 31 patients. Preoperative radiotherapy (45 Gy) was done in 15 cases. After proctectomy the surgical specimen was examined in the operating room. Submucosal peritumoral injections were done. One to three SLNs were retrieved. The SLNs were sectioned at three levels and examined histologically and then, if negative by hematoxylin-eosin (H&E) staining and immunohistochemistry (IHC). There were 7 abdominoperineal resections, 12 colorectal anastomoses, 11 coloanal anastomoses, and 1 Hartmann procedure. The median number of lymph nodes harvested was 21 (7–38). A SLN was identified in 30 cases (feasibility 97%). The mean number of SLNs was 2 (0–3). A micrometastasis was discovered in 3 of 23 pNO cases when H&E was used on multisection levels, thus changing the stage to pN1. Each time the only positive lymph node was the SLN. IHC evaluation did not change the result, as only isolated tumor cells were discovered in one case. Only four of seven N+ patients had a positive SLN, resulting in a false-negative rate of 43%. Ex vivo detection of SLNs is possible for rectal cancer and is a simple technique. Classic analysis using H&E remains the gold standard. However, SLNs detection can change the tumor stage by upstaging nearly 15% of the tumors from T2-3N0 to T2-3 N+.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. International Pooled Analysis of Colon Cancer Trials (IMPACT) Investigators. Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. Lancet 1995;345:939–944

    Google Scholar 

  2. O’Connell MJ, Mailliard JA, Kahn MJ, et al. Controlled trial of fluorouracil and low dose Leucovorin given six months as postoperative adjuvant therapy for colon cancer. J. Clin. Oncol. 1997;15:246–250

    PubMed  Google Scholar 

  3. Hermanek P, Hutter RVP, Sobin LH, et al. TNM Atlas. Illustrated Guide to the TNM/pTNM Classification of Malignant Tumours, 4th edition. Berlin, Springer, 1997

    Google Scholar 

  4. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer 1977;39:456–466

    PubMed  Google Scholar 

  5. Morton D, Cagle L, Wong J, et al. Intraoperative lymphatic mapping and selective lymphadenectomy: technical details of a new procedure for clinical stage I melanoma. Paper presented at the Annual meeting of the Society of Surgical Oncology, Washington, DC.1990

    Google Scholar 

  6. Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann. Surg. 1994;220:391–398

    PubMed  Google Scholar 

  7. Wexner SD, Sands DR. What’s new in colon and rectal surgery. J Am Coll Surg 2003;196:95–103

    Article  PubMed  Google Scholar 

  8. Bilchik AJ, Nora D, Tollenaar RA, et al. Ultrastaging of early colon cancer using lymphatic mapping and molecular analysis. Eur. J. Cancer 2002;38:977–985

    Article  PubMed  Google Scholar 

  9. Lasser P, Côté JF, Sabourin JC et al. Is sentinel lymph node mapping relevant for colon cancer? A feasibility study. Ann. Chir. 2003;128:433–437

    Article  PubMed  Google Scholar 

  10. Saha S, Wiese D, Badin J, et al. Technical details of sentinel lymph node mapping in colorectal cancer and its impact on staging. Ann. Surg. Oncol. 2000;7:120–124

    Article  PubMed  Google Scholar 

  11. Saha S, Bilchick A, Wiese D, et al. Ultrastaging of colorectal cancer by sentinel lymph node mapping technique: a multicenter trial. Ann. Surg. Oncol. 2001;8:94–98

    Google Scholar 

  12. Joosten JJA, Strobbe LJA, Wauters CAP, et al. Intraoperative lymphatic mapping and the sentinel node concept in colorectal carcinoma. Br. J. Surg. 1999;86:482–486

    Article  PubMed  Google Scholar 

  13. Wood TF, Sana S, Morton DL, et al. Validation of lymphatic mapping in colorectal cancer: in vivo, ex vivo, and laparoscopic techniques. Ann. Surg. Oncol. 2001;8:150–157

    PubMed  Google Scholar 

  14. Wong JH, Steineman S, Calderia C, et al. Ex vivo sentinel node mapping in carcinoma of the colon rectum. Ann. Surg. 2001;233:515–521

    Article  PubMed  Google Scholar 

  15. Fitzgerald TL, Khalifa MA, Al Zahrani M, et al. Exvivo sentinel lymph node biopsy in colorectal cancer: a feasibility study. J. Surg. Oncol. 2002;80:27–32

    Article  PubMed  Google Scholar 

  16. Tsioulias GJ, Wood TF, Morton DL, et al. Lymphatic mapping and focused analysis of sentinel lymph node upstage gastrointestinal neoplasm. Arch. Surg. 2000;135:926–932

    Article  PubMed  Google Scholar 

  17. Feig BW, Curley S, Lucci A, et al. A caution regarding lymphatic mapping in patients with colon cancer. Am. J. Surg. 2001;182:707–712

    Article  PubMed  Google Scholar 

  18. Wood TF, Nora DT, Morton DL, et al. One hundred consecutive cases of sentinel lymph node mapping in early colorectal carcinoma: detection of missed micrometastases. J. Gastrointest. Surg. 2002;6:322–329

    Article  PubMed  Google Scholar 

  19. Esser S, Reilly WT, Riley LB, et al. The role of sentinel lymph node mapping in staging of colon and rectal cancer. Dis. Colon Rectum 2001;4:850–856

    Article  Google Scholar 

  20. Topor B, Acland R, Kolodko V, et al. Mesorectal lymph nodes: their location and distribution within the mesorectum. Dis. Colon Rectum 2003;46:779–785

    Article  PubMed  Google Scholar 

  21. Maurel J, Launoy G, Grosclaude P, et al. Lymph node harvest reporting in patients with carcinoma of the large bowel: a French population based study. Cancer 1998;82:1482–1486

    Article  PubMed  Google Scholar 

  22. Wong JH, Severino R, Honnebier MB, et al. Number of nodes examined and staging accuracy in colorectal carcinoma. J. Clin. Oncol. 1999;17:2896–2900

    PubMed  Google Scholar 

  23. Pocard M, Panis Y, Malassagne B, et al. Assessing the effectiveness of mesorectal excision in rectal cancer: prognostic value of the number of lymph nodes found in resected specimen. Dis Colon Rectum 1998;41:839–845

    Article  PubMed  Google Scholar 

  24. Cimmino VM, Brown AC, Szocik JF, et al. Allergic reaction to isosulfan blue during sentinel node biopsy: a common event. Surgery 2001;130:439–442

    Article  PubMed  Google Scholar 

  25. Boland CR, Sinicrope FA, Brenner DE, et al. Colorectal cancer prevention and treatment. Gastroenterology 2000;118:S115–S128

    Article  PubMed  Google Scholar 

  26. Bendavid Y, Latulippe JF, Younan RJ, et al. Phase I study on sentinel lymph node mapping in colon cancer: a preliminary report. J. Surg. Oncol. 2002;79:81–84

    Article  PubMed  Google Scholar 

  27. Cutait R, Alves VA, Lopes LC, et al. Restaging of colorectal cancer based on the identification of lymph node micrometastases through immunoperoxidase staining of CEA and cytokeratins. Dis. Colon Rectum 1991;34:917–920

    Article  PubMed  Google Scholar 

  28. Calaluce R, Miedema BW, Yesus YW. Micrometastasis in colorectal carcinoma: a review. J. Surg. Oncol. 1998;67:194–202

    Article  PubMed  Google Scholar 

  29. Greenson JK, Isenhart CE, Rice R, et al. Identification of occult metastases in pericolic lymph nodes Dukes’B colorectal cancer patients using monoclonal antibodies against cytokeratin and CC49: correlation with long-term survival. Cancer 1994;73:563–569

    PubMed  Google Scholar 

  30. Adell G, Boeryd B, Franlund B, et al. Occurrence and prognostic importance of micrometastases in regional lymph nodes in Dukes’B colorectal carcinoma: an immunohistochemical study. Eur. J. Surg. 1996;162:637–642

    PubMed  Google Scholar 

  31. Fisher ER, et al. Lack of influence of cytokeratin-positive mini micrometastases in “negative node” patients with colorectal cancer: findings from the national surgical adjuvant breast and bowel projects protocols R-01 and C-01. Dis. Colon. Rectum 2003;46:1021–1026

    Article  PubMed  Google Scholar 

  32. Wiese DA, Saha S, Badin J. Sentinel lymph node mapping in staging of colorectal carcinoma. Am. J. Clin. Pathol. 1999;112:542

    Google Scholar 

  33. Merrie AEH, van Rij AM, Phillips LV, et al. Diagnostic use of the sentinel node in colon cancer. Dis. Colon Rectum 2001;44:410–417

    Article  PubMed  Google Scholar 

  34. Broderick-Villa G, Ko A, O’Connell TX, et al. Does tumor burden limit the accuracy of lymphatic mapping and sentinel lymph node biopsy in colorectal cancer? Cancer J 2002;8:445–450

    PubMed  Google Scholar 

  35. Adam IJ, Mohamdee MO, Martin IG, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 1994;344:707–711

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Lucas Sideris, M.D., for assistance in redaction of the manuscript.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Institut Gustave Roussy, Comprehensive Cancer Center, 39 rue Camille Desmoulins, Villejuif cedex, 94805, France

    Olivier Baton M.D., Philippe Lasser M.D., Dominique Elias M.D., Ph.D. & Marc Pocard M.D., Ph.D.

  2. Department of Pathology, Institut Gustave Roussy, Comprehensive Cancer Center, 39 rue Camille Desmoulins, Villejuif cedex, 94805, France

    Jean-Christophe Sabourin M.D., Ph.D. & Pierre Duvillard M.D.

  3. Department of Medical Oncology, Institut Gustave Roussy, Comprehensive Cancer Center, 39 rue Camille Desmoulins, Villejuif cedex, 94805, France

    Valérie Boige M.D., David Malka M.D., Ph.D. & Michel Ducreux M.D., Ph.D.

Authors
  1. Olivier Baton M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philippe Lasser M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean-Christophe Sabourin M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Valérie Boige M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pierre Duvillard M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dominique Elias M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David Malka M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michel Ducreux M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Marc Pocard M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marc Pocard M.D., Ph.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Baton, O., Lasser, P., Sabourin, JC. et al. Ex Vivo Sentinel Lymph Node Study For Rectal Adenocarcinoma: Preliminary Study. World J. Surg. 29, 1166–1170 (2005). https://doi.org/10.1007/s00268-005-7867-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-7867-0

Keywords

Search

Navigation