Intraoperative Sentinel Node Mapping in the Colon: Potential and Pitfalls

Currie, Andrew

doi:10.1159/000494833

Cited by 13 publications

(5 citation statements)

References 40 publications

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“…ICG assesses anastomotic blood flow more objectively before and after intestinal anastomosis in laparoscopic colorectal surgery and reduces the incidence of AL, which is consistent with the findings of Jafari MD et al (38). Meanwhile, ICG has some advantages in lymph node tracing, such as the ability to precisely locate the distribution of metastatic lymph nodes and anterior lymph nodes, particularly extra-regional lymph nodes, and guide intraoperative lymph node dissection, improve lymph node detection rate after surgery, and reduce the number of missed positive lymph nodes (48,49). Furthermore, ICG can precisely locate the lesion with less intraoperative trauma during laparoscopic colorectal surgery to reduce the hospitalization time.…”

Section: Discussionmentioning

confidence: 99%

Meta analysis of indocyanine green fluorescence in patients undergoing laparoscopic colorectal cancer surgery

Deng

Yang

et al. 2022

Front. Oncol.

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This meta-analysis intended to systematically evaluate the clinical implications of indocyanine green fluorescence (ICG) in patients undergoing laparoscopic colorectal surgery. PubMed, MEDLINE, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Medical Information System and China Biomedical Database were synthetically searched for studies published from inception to April 14, 2022. The randomized controlled trials comparing ICG-use with controls were selected. The incidence of anastomotic leakage (AL), lymph node detection, operation duration, intraoperative bleeding, postoperative morbidity, and hospitalization time were evaluated in summary analysis, and calculated the corresponding 95% confidence intervals (CI). Subsequently, in addition to subgroup analyses, studies for heterogeneity, sensitivity, and publication bias were carried out. Consequently, 3453 patients in the enrolled 15 studies were included; 1616 patients were allocated to the experimental group, and 1837 patients were assigned to the control group. The ICG group had a significantly decreased risk of AL (RR: 0.50, 95% CI: 0.37–0.67) and shorter hospitalization time (SMD: -0.31, 95% CI: -0.54–0.08) compared to the control group. Meanwhile, the ICG showed clearly better lymph node detection (SMD: 0.19, 95% CI: 0.02–0.36). However, when the content of operation duration (SMD: -0.07, 95% CI: -0.30–0.15) and intraoperative bleeding (SMD: -0.16, 95% CI: -0.35–0.04) were compared, no statistical significance was found. Furthermore, the pooled analysis of postoperative morbidity was not statistically significant (RR:0.79, 95% CI: 0.58–1.08). The results of the subgroup analysis of AL indicated that there may be regional variations in AL (RR: 0.50, 95% CI: 0.37–0.67) but not in postoperative morbidity (RR: 0.79, 95% CI: 0.58–1.08). In conclusion, the application of ICG in laparoscopic colorectal surgery can effectively reduce the AL, lymph node detection, and hospitalization time. However, more multicenter large-sample randomized controlled trials are required to further confirm its advantages. The meta-analysis was registered in PROSPERO (no. CRD42022288054).

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Section: Discussionmentioning

confidence: 99%

Meta analysis of indocyanine green fluorescence in patients undergoing laparoscopic colorectal cancer surgery

Deng

Yang

et al. 2022

Front. Oncol.

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“…1), is the current-standard-of-care for treating a variety of cancer types, including breast, skin, vulvar, and cervical cancer [1]. The effectiveness of SLN-harvesting in abdominal primary cancers [2], such as endometrial [3], gastric [4], colon [5], and prostate cancer [6], has been the subject of extensive clinical research.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Probe for Sentinel Lymph Node Harvesting Using Magnetic Nanoparticles

Loosdrecht

Molenaar

Krooshoop

et al. 2022

IEEE Trans. Biomed. Eng.

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Sentinel lymph node harvesting is an essential step in the surgical treatment of a growing number of malignancies. Various techniques are available to facilitate this purpose. The present study reports a new laparoscopic technique for lymph node harvesting using magnetic nanoparticles containing a superparamagnetic iron-oxide core and dextran coating. This study assesses the clinical relevance of the prototype and provides input for further technological development on the way to clinical implementation. Methods: A laparoscopic differential magnetometer prototype was built, utilizing a nonlinear detection principle (differential magnetometry) for magnetic identification of lymph nodes. The iron content sensitivity, depth & spatial sensitivity, and angular sensitivity were analyzed to investigate clinical options. Results: The minimum detectable amount of iron was 9.8 μg at a distance of 1 mm. The detection depth was 5, 8, and 10 mm for samples containing 126, 252, and 504 µg iron, respectively. The maximum lateral detection distance was 5, 7, and 8 mm for samples containing 126, 252, and 504 µg iron, respectively. A sample containing 504 µg iron was detectable at all angulations assessed (0°, 30°, 60° and 90°). Conclusion: The laparoscopic differential magnetometer demonstrates promising results for further investigation and development towards laparoscopic lymph node harvesting using magnetic nanoparticles. Significance: The laparoscopic differential magnetometer facilitates a novel method for sentinel lymph node harvesting, which helps to determine prognosis and treatment of cancer patients.

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“…During the current routine en-bloc resection, a section of colon and mesocolon is removed including fatty tissue with (S)LNs. 6 In vivo tracer injection or ex vivo tracer injection can potentially facilitate the iden-ti¯cation of SLNs. Although tracer spread of in vivo injections is expected to be superior, added patient burden is also anticipated.…”

Section: Introductionmentioning

confidence: 99%

Quantification of Magnetic Nanoparticles in ex vivo Colorectal Lymph Nodes

et al. 2022

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En-bloc tumor resection is the standard treatment for locally advanced colorectal cancer (CRC). An extensive histopathological assessment is necessary to evaluate the metastatic spread and adjuvant therapy. Sentinel lymph node biopsy decreases the histopathological burden when only sentinel lymph nodes (SLNs) are examined. This study aims to evaluate the spread of a magnetic tracer throughout the lymphatic system after ex vivo injection in en-bloc resected specimens of patients with CRC. To achieve this, lymph nodes (LNs) were quantified using a new magnetic detection method. Fifteen patients with CRC diagnosed with clinically negative LNs were included in this study and received 2–4 ex vivo magnetic tracer injections (total volume of 2[Formula: see text]mL). Magnetic sample series were acquired to create a look-up table for magnetic tracer quantification. In 80% of the patients, at least one magnetic LN was detected. A total of 33 LNs were marked as magnetic, containing an average of 8.1[Formula: see text][Formula: see text]g iron. In 71% of the patients, metastases were found in nonmagnetic LNs. Ex vivo injection leads to sub-optimal tracer spread and therefore inaccurate diagnosis. This study presents a novel magnetic detection method to quantify magnetic tracer in lymph nodes. Detecting the SLNs in en-bloc resected specimens and involving only these LNs in histopathological investigation enable a decrease in healthcare costs or an increased diagnostic potential.

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Intraoperative Sentinel Node Mapping in the Colon: Potential and Pitfalls

Cited by 13 publications

References 40 publications

Meta analysis of indocyanine green fluorescence in patients undergoing laparoscopic colorectal cancer surgery

Meta analysis of indocyanine green fluorescence in patients undergoing laparoscopic colorectal cancer surgery

Laparoscopic Probe for Sentinel Lymph Node Harvesting Using Magnetic Nanoparticles

Quantification of Magnetic Nanoparticles in ex vivo Colorectal Lymph Nodes

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