Sağ kolon kanseri cerrahisinde floresans görüntüleme ile lenfanjiyografinin katkılarının retrospektif incelenmesi
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Date
2022
Authors
Şen, Murat
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Journal ISSN
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Kolorektal kanser, dünya çapında en yaygın üçüncü kanserdir. Beş yıllık sağkalım erken hastalıkta %90 seviyesinden metastatik hastalıkta %10 seviyesine kadar değişebildiğinden, nodal tutulum sağkalımı etkileyen önemli faktörlerden biridir. Kolon kanseri cerrahisinde toplanan lenf nodu sayısının prognoz ile doğru orantılı olduğu kanıtlanmıştır. Sonuçları iyileştirmek amacıyla, komplet mezokolik eksizyon (KME) tekniği tanımlanmıştır. Daha fazla lenf nodu toplamak KME tekniğinin amaçlarından biridir. Bu nedenle kolon kanseri cerrahisinde daha fazla lenf nodu toplamak için geliştirilecek yeni yöntemlerin büyük önem arz etmektedir. Floresans görüntüleme teknolojisi, lenfanjiyografi ve lenfatik haritalamayı mümkün kılmaktadır. Bu çalışmada sağ kolonun belirli seviyelerinde anterior ve posterior yüzlere ve peritümöral alana submukozal indosiyanin yeşili (ICG) enjeksiyonu ile lenfatik haritalama tekniği kullanılarak kolektomi ameliyatı yapılan hastaların verileri incelenmiştir. Lenfatik haritalama yapılan 10 hasta (S grubu) ile 1:2 oranında karşılaştırılan 20 hasta (C grubu) arasında yaş, ASA skoru, tümör yerleşimi, tümör T ve N evreleri ve prognoza etkili patolojik belirteçler bakımından farklılık bulunmamıştır. Her iki grubun ameliyat süreleri benzerdir. C grubunda %10 oranında intraoperatif komplikasyon görülse de istatistiksel olarak anlamlı bulunmamıştır (p=0,540). Lenfanjiyografi sonrası rezeksiyon lojunda ICG tutan lenf nodları tespit edilmiş ve bu lenf nodları ayrı kaplarda patolojik inceleme için gönderilmiştir. Ayrı gönderilen lenf nodu sayısına iii bakıldığında haritalama yapılan S grubunda anlamlı olarak daha fazla lenf nodu gönderildiği tespit edilmiştir (p=0,001). Sağ kolon kanserinin cerrahi tedavisinde ICG ile lenfatik haritalama tekniğinin ameliyat süresini uzatmadan ve güvenle uygulanabilir olduğunu gösterdiğimiz çalışmamızda yapılan lenfanjiyografi ile rezeksiyon alanında rezidü kalan ve ayrı olarak eksize edilen lenf nodları ile lenfadenektominin sınırlarını genişletebildiğimizi ve bunu yaparken özellikle vasküler yaralanmaları içeren intraoperatif komplikasyonları arttırmadığımızı göstermiş bulunmaktayız. Böylelikle KME’nin önemli sorunu olan vasküler yaralanmadan kaçınarak selektif olarak D3 lenf nodu diseksiyonu mümkün olabilir.
Colorectal cancer is the third most common cancer worldwide. Since 5-year survival can range from 90% in early disease to 10% in metastatic disease, nodal involvement is one of the important factors affecting survival. It has been proven that the number of lymph nodes collected in colon cancer surgery is directly proportional to the prognosis. To improve the results, the complete mesocolic excision (CME) technique has been described. Collecting more lymph nodes is one of the main goals in CME technique. New methods to be developed to collect more lymph nodes in colon cancer surgery are of great importance. The importance of new methods to be developed to collect more lymph nodes in colon cancer surgery is considerable. Fluorescence imaging technology enables lymphangiography and lymphatic mapping. The data of patients were analyzed who underwent colectomy surgery using lymphatic mapping technique with submucosal indocyanine green (ICG) injection to the anterior and posterior surfaces and the peritumoral area at certain levels of the right colon. There was no difference in age, ASA score, tumor location, tumor T and N stages, and pathological markers affecting prognosis between 10 patients (group S) who underwent lymphatic mapping and 20 patients (group C) compared at a ratio of 1:2. The operation times of the two groups were similar. Although 10% of intraoperative complications were seen in group C, it was not statistically significant (p=0.540). After lymphangiography, lymph nodes containing ICG were detected in the resection site and these lymph nodes were sent to pathology in separate containers. Considering the number of lymph nodes sent separately, it was v determined that significantly more lymph nodes were sent in the S group (p=0.001). In our study, where we showed that the lymphatic mapping technique with ICG can be safely applied in the surgical treatment of right colon cancer, without prolonging the operation time, we have shown that we can expand the limits of lymphadenectomy with lymph nodes that are left in the resection area and are excised separately, and that we do not increase intraoperative complications, especially including vascular injuries, by lymphangiography. Thus, selective D3 lymph node dissection may be possible, avoiding vascular injury, which is an important problem of CME.
Colorectal cancer is the third most common cancer worldwide. Since 5-year survival can range from 90% in early disease to 10% in metastatic disease, nodal involvement is one of the important factors affecting survival. It has been proven that the number of lymph nodes collected in colon cancer surgery is directly proportional to the prognosis. To improve the results, the complete mesocolic excision (CME) technique has been described. Collecting more lymph nodes is one of the main goals in CME technique. New methods to be developed to collect more lymph nodes in colon cancer surgery are of great importance. The importance of new methods to be developed to collect more lymph nodes in colon cancer surgery is considerable. Fluorescence imaging technology enables lymphangiography and lymphatic mapping. The data of patients were analyzed who underwent colectomy surgery using lymphatic mapping technique with submucosal indocyanine green (ICG) injection to the anterior and posterior surfaces and the peritumoral area at certain levels of the right colon. There was no difference in age, ASA score, tumor location, tumor T and N stages, and pathological markers affecting prognosis between 10 patients (group S) who underwent lymphatic mapping and 20 patients (group C) compared at a ratio of 1:2. The operation times of the two groups were similar. Although 10% of intraoperative complications were seen in group C, it was not statistically significant (p=0.540). After lymphangiography, lymph nodes containing ICG were detected in the resection site and these lymph nodes were sent to pathology in separate containers. Considering the number of lymph nodes sent separately, it was v determined that significantly more lymph nodes were sent in the S group (p=0.001). In our study, where we showed that the lymphatic mapping technique with ICG can be safely applied in the surgical treatment of right colon cancer, without prolonging the operation time, we have shown that we can expand the limits of lymphadenectomy with lymph nodes that are left in the resection area and are excised separately, and that we do not increase intraoperative complications, especially including vascular injuries, by lymphangiography. Thus, selective D3 lymph node dissection may be possible, avoiding vascular injury, which is an important problem of CME.
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Keywords
Kolon kanseri, Floresans görüntüleme, Lenfatik haritalama, Colon cancer, Lymphatic mapping, Fluorescence imaging
Citation
Şen, M. (2022). Sağ kolon kanseri cerrahisinde floresans görüntüleme ile lenfanjiyografinin katkılarının retrospektif incelenmesi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.