Use of intraoperative luminescent methods for detecting affected lymph nodes in patients with complicated forms of colon cancer
DOI:
https://doi.org/10.14739/mmt.2024.4.307038Keywords:
colorectal cancer, diagnosis, complications, photoluminescence examination, fluorescein, lymph nodes, lymphographyAbstract
The issue of the volume of lymphatic dissection in patients with complicated forms of colon cancer and the possibility of using methods of intraoperative visualisation of the affected lymph nodes remains controversial.
The aim of the study – to analyse the results of using the intraoperative luminescent method of detecting affected lymph nodes in patients with complicated forms of malignant diseases of the large intestine.
Materials and methods. The study group included 109 patients with complicated forms of colon cancer. In the gender structure, female patients predominated – 57 (52.29 %), there were 52 (47.71 %) men. The average age of the patients was 69.78 ± 16.37 years. Contrasting of regional lymph nodes was carried out using a 10 % sodium fluorescein solution.
Results. According to the results of the fluorescence examination, in 67 (61.47 %) patients, lymph nodes were visualized in the regional lymphatic outflow: in 39 (58.21 %) cases, the visualized lymph nodes were located in the area of epi- and paracolic nodes (lymphodissection D1), in 23 (34.33 %) of patients – in the zone of mesocolic lymph nodes (lymphodissection D2) and in 5 (7.46 %) – in the zone of apical lymph nodes (3rd level of lymph drainage). A total of 268 lymph nodes were detected in 109 patients, which was an average of 2.46 lymph nodes per 1 patient. These nodes were marked and sent for histological examination separately from the main preparation. In total, a pathohistological examination of 1436 lymph nodes from the regional zone of lymph drainage from colon cancer was carried out, which was an average of 13.17 lymph nodes per 1 patient.
Conclusions. The use of a 10 % solution of sodium fluorescein as a preparation for photoluminescence examination made it possible to visualize lymph nodes in the regional lymphatic outflow zone for the tumor in 67 (61.47 %) patients. The use of photoluminescence made it possible to determine the optimal volumes of lymphatic dissection without unjustified expansion in the case of surgical interventions for complicated forms of colon cancer. The levels of sensitivity and specificity of the photoluminescent method of detecting affected lymph nodes using a 10 % solution of sodium fluorescein had quite high results and amounted to 72.41 % and 93.28 %, respectively.
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