Zurück

ID: 460 (Conflict of Interest: K)

Eine neue Ära in der Kolonchirurgie: Etablierung der Darstellung mesokolischer Lymphknoten mittels Indocyaningrün (ICG)

M.Kalandarishvili, M.Kaspari, G.Winde, E. W.Kolbe
Klinikum Herford, Herford

Einleitung

Definitive treatment of colon cancer includes radical resection and in defined nodal positive cases adjuvant chemotherapy. Localisation and penetration depth of the tumour defines the extent of the operation. Lymphadenectomy in this procedure is standardized, but in some cases the degree of this resection is debatable. Furthermore, the role of sentinel lymph node (SLN) mapping in colon cancer is not clarified so far.

Material und Methoden

Since April 2019 eight patients with colon cancer underwent radical laparoscopic assisted resection. After tumour identification due to palpation or after detecting the color coding marking of the preoperative colonoscopy, 10-20 mg of diluted indocyanine green (ICG) was injected into the colonic wall nearby the tumour location. Indocyanine green is distributed via lymphatic tissue and accumulate at the lymph nodes. ICG is detected via a specialized fluorescence system (TC300, TCD201, TH102, 20133720, Karl Storz, Tuttlingen, Germany) exciting the ICG and assessing lymphatics in real time. The SLN is identified by a clear bright green fluorescence and marked using a metal clip to facilitate the further histopathological examinations.

Ergebnisse

After applying ICG the SLN was identified 10-20 minutes later, 50-70 minutes after ICG injection the whole lymphatic drainage is visible. The SLN identified via ICG fluorescence could be verified histologically in 6/8 cases.

Schlussfolgerung

Detecting and resection of SLN in colon cancer is not established so far. According to our results it is feasible to retrace the propagation track of the colon cancer via lymphatic tissue spreading in real time using ICG. The SLN detected by ICG illumination is confirmed by histological elaboration in most cases. So additional questions could be answered in further studies: Is there a correlation between the data gained by SLN/ICG staining and the well-known anatomic borders of lymphatic tissue related to the arterial vascular system of the colon? Are there histologically nodal positive cases, whereas the SNL is identified but not infiltrated by colon cancer cells, especially in earlier pT-stages? Is there a possibility to have nodal positive cases without a positive SNL staining, e.g. by lymphatic bypassing of cancer cells? Is the SNL comparable to the central lymph node in the anatomic radical central resection site.

So far, ICG imaging of the lymphatic system in colon cancer is at least an appropriate method to secure the extent of performing a radical mesocolic excision and particularly identifying the deepest layer of the central lymph nodes.