Abstract
BackgroundCarbon nanoparticles show significant lymphatic tropism and can be used to identify lymph nodes surrounding mid-low rectal tumors. In this study, we analyzed the effect of trans anal injection of a carbon nanoparticle suspension on the outcomes of patients with mid-low rectal cancer who underwent laparoscopic resection.MethodsWe collected the data of 87 patients with mid-low rectal cancer who underwent laparoscopic resection between November 2014 and March 2015 at Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College. For 35 patients in the experimental group, the carbon nanoparticle suspension was injected transanally into the submucosa of the rectum around the tumor 30 min before the operation; 52 patients in the control group underwent the operation directly without the injection of carbon nanoparticle suspension. We then compared the operation outcomes between the two groups.ResultsIn the experimental group, the rate of incomplete mesorectal excision was lower than that in the control group, but no significant difference was found (2.9% vs. 7.7%, P = 0.342). The distance between the tumor and the circumferential resection margin was 5.8 ± 1.4 mm in the experimental group and 4.8 ± 1.1 mm in the control group (P = 0.001). The mean number of lymph nodes removed was 28.2 ± 9.4 in the experimental group and 22.7 ± 7.3 in the control group (P = 0.003); the mean number of lymph nodes smaller than 5 mm in diameter was 10.1 ± 7.5 and 4.5 ± 3.7, respectively (P < 0.001). Three patients in the experimental group received lateral lymph node resection. Among the three patients, we retrieved three nodes (one stained node) from the first patient, three nodes (two stained nodes) from the second patient, and two nodes (no stained nodes) from the third patient.ConclusionsInjecting a carbon nanoparticle suspension improved the outcomes of patients who underwent laparoscopic resection for mid-low rectal cancer; it also improved the accuracy of pathologic staging. Moreover, for selected patients, this technique narrowed the scope of lateral lymph node dissection.
Highlights
Carbon nanoparticles show significant lymphatic tropism and can be used to identify lymph nodes surrounding mid-low rectal tumors
Submucosal injection of a carbon nanoparticle suspension around the tumor may be associated with operation outcomes and rectal cancer prognosis [12]
Pathologic results The rate of incomplete mesorectal excision in the experimental group was lower than that in the control group (2.9% vs. 7.7%), no significant difference was found (P = 0.342)
Summary
Carbon nanoparticles show significant lymphatic tropism and can be used to identify lymph nodes surrounding mid-low rectal tumors. We analyzed the effect of trans anal injection of a carbon nanoparti‐ cle suspension on the outcomes of patients with mid-low rectal cancer who underwent laparoscopic resection. Since 1988, Yoshida et al [11] have reported that carbon nanoparticles, which are useful, non-toxic, lymphatic tracers, have high lymphatic tropism and can reside for long periods of time in the lymph nodes. Submucosal injection of a carbon nanoparticle suspension around the tumor may be associated with operation outcomes and rectal cancer prognosis [12]. Between November 2014 and March 2015, for selected patients with mid-low rectal cancer, we performed submucous injections of carbon nanoparticle suspensions immediately prior to laparoscopic resection. We evaluated the effect of the injection on the operation outcomes and on postoperative pathologic analyses
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