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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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.
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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.
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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