Effect of Carbon Nanoparticles on Lymph Node Yield in Radical Operation of Rectal Cancer after Neoadjuvant Chemoradiotherapy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHOUHai-tao ¹ , DOULi-zhou ² , WANGGui-qi ² , LIANGJian-wei ¹ , LIUQian ¹ , SUHao ¹ , SHANYi ¹ , ZHAOHong ¹ , PEIWei ¹ , HUANGZhen ¹ , WANGZheng ¹ , ZENGWei-gen ¹ , LIUXin ¹ ,  ZHOUZhi-xiang ¹

1. Department of Abdominal Surgery, Cancer Hospital (Institute), Chinese Academy of Medical Science, Beijing 100021, China;
2. Department of Endoscopy, Cancer Hospital (Institute), Chinese Academy of Medical Science, Beijing 100021, China;

Corresponding author：

ZHOUZhi-xiang, Email: zhouzx01@163.com

Keywords：

Rectal cancer; Neoadjuvant chemoradiotherapy; Lymph node; Carbon nanoparticles

DOI：

10.7507/1007-9424.20160152

Video：

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Objective To investigate effect of carbon nanoparticles on number of lymph nodes harvested in radical operation of rectal cancer after neoadjuvant chemoradiotherapy. Methods One hundred and five patients diagnosed with low and middle rectal cancer and received radical operation after neoadjuvant chemoradiotherapy in Cancer Hospital, Chinese Academy of Medical Sciences from March 1, 2014 to October 31, 2015 were included. Thirtysix patients were injected with carbon nanoparticles by colonoscopy before surgery and were classified as study group, and the rest patients were classified as control group. According to the same principle of surgery and procedure of pathological specimen handling, the effect of carbon nanoparticles on lymph node harvested in resected specimens was analyzed. Results The total lymph nodes harvested were 764 in the study group and 1 242 in the control group. Among them, the metastatic lymph nodes were 19 in the study group, 58 in the control group. Although the average lymph nodes harvested in each patient had no significant difference between the study group and the control group (21.22±7.13 versus 18.00±9.84, t=1.739, P=0.085), the proportion of patients with 12 or more than 12 lymph nodes harvested in the study group was significantly higher than that in the control group [88.9% (32/36) versus 71.0% (49/69), χ²=4.287, P=0.038]. The ratio of patients with metastatic lymph nodes [27.8% (10/36) versus 33.3% (23/69), χ²=0.339, P=0.561] and the average metastatic lymph nodes harvested in each patient (1.90±1.29 versus 2.52±2.33, t=0.788, P=0.437) all had no significant differences between the study group and the control group. Conclusion The injection of carbon nanoparticles by colonoscopy before surgery could increase detection rate of 12 or more than 12 lymph nodes in resected specimens of patients who were diagnosed with low and middle rectal cancer and received radical operation after neoadjuvant chemoradiotherapy.

Citation： ZHOUHai-tao, DOULi-zhou, WANGGui-qi, LIANGJian-wei, LIUQian, SUHao, SHANYi, ZHAOHong, PEIWei, HUANGZhen, WANGZheng, ZENGWei-gen, LIUXin, ZHOUZhi-xiang. Effect of Carbon Nanoparticles on Lymph Node Yield in Radical Operation of Rectal Cancer after Neoadjuvant Chemoradiotherapy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(5): 565-568. doi: 10.7507/1007-9424.20160152 Copy

1.	Edge SB, Compton CC. The american joint committee on cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6):1471-1474.
2.	Norwood MG, Sutton AJ, West K, et al. Lymph node retrieval in colorectal cancer resection specimens:national standards are achievable, and low numbers are associated with reduced survival. Colorectal Dis, 2010, 12(4):304-309.
3.	Murphy J, Pocard M, Jass JR, et al. Number and size of lymph nodes recovered from Dukes B rectal cancers:correlation with prognosis and histologic antitumor immune response. Dis Colon Rectum, 2007, 50(10):1526-1534.
4.	Swanson RS, Compton CC, Stewart AK, et al. The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol, 2003, 10(1):65-71.
5.	Marks JH, Valsdottir EB, Rather AA, et al. Fewer than 12 lymph nodes can be expected in a surgical specimen after high-dose chemoradiation therapy for rectal cancer. Dis Colon Rectum, 2010, 53(7):1023-1029.
6.	杨凯, 侯远发, 宋耀明, 等.直肠癌新辅助治疗后手术标本的淋巴结检出.中国实用医药, 2014, 9(11):79-80.
7.	王镇, 郭澎, 于晨.纳米碳标记对直肠癌根治术淋巴结检出率的影响.潍坊医学院学报, 2012, 34(6):452-454.
8.	彭亦凡, 姚云峰, 王林, 等.纳米碳示踪剂标记前哨淋巴结在结肠癌根治术中的应用.中华普通外科杂志, 2013, 28(6):409-412.
9.	Cianchi F, Palomba A, Boddi V, et al. Lymph node recovery from colorectal tumour specimens:recommendation for a minimum number of lymph nodes to be examined. World J Surg, 2002, 26(3): 384-389.
10.	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 specimens. Dis Colon Rectum, 1998, 41(7):839-845.
11.	Tepper JE, O'Connell MJ, Niedzwiecki D, et al. Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol, 2001, 19(1):157-163.
12.	Scott KW, Grace RH. Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg, 1989, 76(11): 1165-1167.
13.	Hernanz F, Revuelta S, Redondo C, et al. Colorectal adenocarcinoma: quality of the assessment of lymph node metastases. Dis Colon Rectum, 1994, 37(4):373-376.
14.	Mukai M, Sato S, Nishida T, et al. Selection criteria for high risk and low risk groups of recurrence and metastasis in patients with primary colorectal cancer. Oncol Rep, 2003, 10(6):1753-1758.
15.	Luna-Perez P, Rodriguez-Ramirez S, Alvarado I, et al. Prognostic significance of retrieved lymph nodes per specimen in resected rectal adenocarcinoma after preoperative chemoradiation therapy. Arch Med Res, 2003, 34(4):281-286.
16.	Caplin S, Cerottini JP, Bosman FT, et al. For patients with Dukes' B (TNM StageⅡ) colorectal carcinoma, examination of six or fewer lymph nodes is related to poor prognosis. Cancer, 1998, 83(4):666-672.
17.	Tsai HL, Lu CY, Hsieh JS, et al. The prognostic significance of total lymph node harvest in patients with T2-4N0M0 colorectal cancer. J Gastrointest Surg, 2007, 11(5):660-665.
18.	Evans MD, Barton K, Rees A, et al. The impact of surgeon and pathologist on lymph node retrieval in colorectal cancer and its impact on survival for patients with Dukes' stage B disease. Colorectal Dis, 2008, 10(2):157-164.
19.	Mekenkamp LJ, van Krieken JH, Marijnen CA, et al. Lymph node retrieval in rectal cancer is dependent on many factors:the role of the tumor, the patient, the surgeon, the radiotherapist, and the pathologist. Am J Surg Pathol, 2009, 33(10):1547-1553.
20.	Morcos B, Baker B, Al Masri M, et al. Lymph node yield in rectal cancer surgery:Effect of preoperative chemoradiotherapy. Eur J Surg Oncol, 2010, 36(4):345-349.
21.	Wright FC, Law CH, Last L, et al. Lymph node retrieval and assessment in stageⅡcolorectal cancer:a population-based study. Ann Surg Oncol, 2003, 10(8):903-909.
22.	Shvero J, Koren R, Marshak G, et al. Histological changes in the cervical lymph nodes after radiotherapy. Oncol Rep, 2001, 8(4):909-911.
23.	Fajardo LF. Effects of ionizing radiation on lymph nodes. A review. Front Radiat Ther Oncol, 1994, 28:37-45.
24.	Ha YH, Jeong SY, Lim SB, et al. Influence of preoperative chemoradiotherapy on the number of lymph nodes retrieved in rectal cancer. Ann Surg, 2010, 252(2):336-340.
25.	Miller ED, Robb BW, Cummings OW, et al. The effects of preoperative chemoradiotherapy on lymph node sampling in rectal cancer. Dis Colon Rectum, 2012, 55(9):1002-1007.
26.	Damin DC, Rosito MA, Contu PC, et al. Lymph node retrieval after preoperative chemoradiotherapy for rectal cancer. J Gastrointest Surg, 2012, 16(8):1573-1580.
27.	Hao RT, Chen J, Zhao LH, et al. Sentinel lymph node biopsy using carbon nanopartieles for Chinese patients with papillary thyroid microcarcinoma. Eur J Surg Oncol, 2012, 38(8):718-724.
28.	姜润学, 蔡海峰, 胡万宁, 等.纳米炭在腹腔镜下进展期直肠癌根治术中的应用.中国肿瘤临床, 2013, 40(18):1123-1126.
29.	Yan J, Xue F, Chen H, et al. A multi-center study of using carbon nanoparticles to track lymph node metastasis in T1-2 colorectal cancer. Surg Endosc, 2014, 28(12):3315-3321.

1. Edge SB, Compton CC. The american joint committee on cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6):1471-1474.
2. Norwood MG, Sutton AJ, West K, et al. Lymph node retrieval in colorectal cancer resection specimens:national standards are achievable, and low numbers are associated with reduced survival. Colorectal Dis, 2010, 12(4):304-309.
3. Murphy J, Pocard M, Jass JR, et al. Number and size of lymph nodes recovered from Dukes B rectal cancers:correlation with prognosis and histologic antitumor immune response. Dis Colon Rectum, 2007, 50(10):1526-1534.
4. Swanson RS, Compton CC, Stewart AK, et al. The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol, 2003, 10(1):65-71.
5. Marks JH, Valsdottir EB, Rather AA, et al. Fewer than 12 lymph nodes can be expected in a surgical specimen after high-dose chemoradiation therapy for rectal cancer. Dis Colon Rectum, 2010, 53(7):1023-1029.
6. 杨凯, 侯远发, 宋耀明, 等.直肠癌新辅助治疗后手术标本的淋巴结检出.中国实用医药, 2014, 9(11):79-80.
7. 王镇, 郭澎, 于晨.纳米碳标记对直肠癌根治术淋巴结检出率的影响.潍坊医学院学报, 2012, 34(6):452-454.
8. 彭亦凡, 姚云峰, 王林, 等.纳米碳示踪剂标记前哨淋巴结在结肠癌根治术中的应用.中华普通外科杂志, 2013, 28(6):409-412.
9. Cianchi F, Palomba A, Boddi V, et al. Lymph node recovery from colorectal tumour specimens:recommendation for a minimum number of lymph nodes to be examined. World J Surg, 2002, 26(3): 384-389.
10. 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 specimens. Dis Colon Rectum, 1998, 41(7):839-845.
11. Tepper JE, O'Connell MJ, Niedzwiecki D, et al. Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol, 2001, 19(1):157-163.
12. Scott KW, Grace RH. Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg, 1989, 76(11): 1165-1167.
13. Hernanz F, Revuelta S, Redondo C, et al. Colorectal adenocarcinoma: quality of the assessment of lymph node metastases. Dis Colon Rectum, 1994, 37(4):373-376.
14. Mukai M, Sato S, Nishida T, et al. Selection criteria for high risk and low risk groups of recurrence and metastasis in patients with primary colorectal cancer. Oncol Rep, 2003, 10(6):1753-1758.
15. Luna-Perez P, Rodriguez-Ramirez S, Alvarado I, et al. Prognostic significance of retrieved lymph nodes per specimen in resected rectal adenocarcinoma after preoperative chemoradiation therapy. Arch Med Res, 2003, 34(4):281-286.
16. Caplin S, Cerottini JP, Bosman FT, et al. For patients with Dukes' B (TNM StageⅡ) colorectal carcinoma, examination of six or fewer lymph nodes is related to poor prognosis. Cancer, 1998, 83(4):666-672.
17. Tsai HL, Lu CY, Hsieh JS, et al. The prognostic significance of total lymph node harvest in patients with T2-4N0M0 colorectal cancer. J Gastrointest Surg, 2007, 11(5):660-665.
18. Evans MD, Barton K, Rees A, et al. The impact of surgeon and pathologist on lymph node retrieval in colorectal cancer and its impact on survival for patients with Dukes' stage B disease. Colorectal Dis, 2008, 10(2):157-164.
19. Mekenkamp LJ, van Krieken JH, Marijnen CA, et al. Lymph node retrieval in rectal cancer is dependent on many factors:the role of the tumor, the patient, the surgeon, the radiotherapist, and the pathologist. Am J Surg Pathol, 2009, 33(10):1547-1553.
20. Morcos B, Baker B, Al Masri M, et al. Lymph node yield in rectal cancer surgery:Effect of preoperative chemoradiotherapy. Eur J Surg Oncol, 2010, 36(4):345-349.
21. Wright FC, Law CH, Last L, et al. Lymph node retrieval and assessment in stageⅡcolorectal cancer:a population-based study. Ann Surg Oncol, 2003, 10(8):903-909.
22. Shvero J, Koren R, Marshak G, et al. Histological changes in the cervical lymph nodes after radiotherapy. Oncol Rep, 2001, 8(4):909-911.
23. Fajardo LF. Effects of ionizing radiation on lymph nodes. A review. Front Radiat Ther Oncol, 1994, 28:37-45.
24. Ha YH, Jeong SY, Lim SB, et al. Influence of preoperative chemoradiotherapy on the number of lymph nodes retrieved in rectal cancer. Ann Surg, 2010, 252(2):336-340.
25. Miller ED, Robb BW, Cummings OW, et al. The effects of preoperative chemoradiotherapy on lymph node sampling in rectal cancer. Dis Colon Rectum, 2012, 55(9):1002-1007.
26. Damin DC, Rosito MA, Contu PC, et al. Lymph node retrieval after preoperative chemoradiotherapy for rectal cancer. J Gastrointest Surg, 2012, 16(8):1573-1580.
27. Hao RT, Chen J, Zhao LH, et al. Sentinel lymph node biopsy using carbon nanopartieles for Chinese patients with papillary thyroid microcarcinoma. Eur J Surg Oncol, 2012, 38(8):718-724.
28. 姜润学, 蔡海峰, 胡万宁, 等.纳米炭在腹腔镜下进展期直肠癌根治术中的应用.中国肿瘤临床, 2013, 40(18):1123-1126.
29. Yan J, Xue F, Chen H, et al. A multi-center study of using carbon nanoparticles to track lymph node metastasis in T1-2 colorectal cancer. Surg Endosc, 2014, 28(12):3315-3321.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of Carbon Nanoparticles on Lymph Node Yield in Radical Operation of Rectal Cancer after Neoadjuvant Chemoradiotherapy

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