Early results of fluorescence lymphatic mapping for right colon cancer: a case-matched study

Abstract

Objectives: The complete mesocolic excision (CME) technique has been described to improve the surgical outcomes of colon cancer. Collecting more lymph nodes is one of the goals of CME. In our study, indocyanine green (ICG) injection was applied to the anterior and posterior walls at certain levels of the right colon. The aim of this study is to determine the impact of lymphangiography in right colon cancer surgery.

Methods: The data of patients were analyzed who underwent colectomy surgery between 1.1.2018-1.1.2022 and using our mapping technique. A case-match study was performed at a ratio of 1:2 (Study group [group S; n =10], Control group [group C; n = 20]). Case-matched criteria were age +/-10, T stage +/-1, and tumor location.

Results: There were no differences in terms of age, the American Society of Anesthesiologists score, tumor location, tumor T and N stages, and pathological markers affecting prognosis between the groups. 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 determined that significantly more lymph nodes were sent in the group S (p = 0.001).

Conclusions: We have shown that the ICG mapping can be applied safely in the surgical treatment of right colon cancer.

Keywords

• Colonic neoplasms
• Indocyanine green
• lymphatic metastasis
• fluorescence lymphatic mapping

References

1. 1. Emile SH, Elfeki H, Shalaby M, et al. Sensitivity and specificity of indocyanine green near-infrared fluorescence imaging in detection of metastatic lymph nodes in colorectal cancer: Systematic review and meta-analysis. J Surg Oncol. 2017;116(6):730-740. doi: 10.1002/jso.24701
2. 2. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis. 2009;11(4):354-64. doi: 10.1111/j.1463-1318.2008.01735.x.
3. 3. Park SY, Park JS, Kim HJ, Woo IT, Park IK, Choi GS. Indocyanine green fluorescence imaging-guided laparoscopic surgery could achieve radical D3 dissection in patients with advanced right-sided colon cancer. Dis Colon Rectum. 2020;63(4):441-449. doi: 10.1097/DCR.0000000000001597.
4. 4. Chand M, Keller DS, Joshi HM, Devoto L, Rodriguez-Justo M, Cohen R. Feasibility of fluorescence lymph node imaging in colon cancer: FLICC. Tech Coloproctol. 2018;22(4):271-277. doi: 10.1007/s10151-018-1773-6.
5. 5. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality dorldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi: 10.3322/caac.21660.
6. 6. Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020;70(3):145-164. doi: 10.3322/caac.21601.
7. 7. Heald RJ. The 'Holy Plane' of rectal surgery. J R Soc Med. 1988;81(9):503-508. doi: 10.1177/014107688808100904.
8. 8. Le Voyer TE, Sigurdson ER, Hanlon AL, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol. 2003;21(15):2912-2919. doi: 10.1200/JCO.2003.05.062.

9. 9. Schumacher P, Dineen S, Barnett C Jr, Fleming J, Anthony T. The metastatic lymph node ratio predicts survival in colon cancer. Am J Surg. 2007;194(6):827-831. doi: 10.1016/j.amjsurg.2007.08.030.
10. 10. Mammen JM, James LE, Molloy M, Williams A, Wray CJ, Sussman JJ. The relationship of lymph node dissection and colon cancer survival in the Veterans Affairs Central Cancer Registry. Am J Surg. 2007 ;194(3):349-354. doi: 10.1016/j.amjsurg.2006.08.092.
11. 11. West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol. 2008;9(9):857-865. doi: 10.1016/S1470- 2045(08)70181-5.
12. 12. Bertelsen CA, Neuenschwander AU, Jansen JE, et al. Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol. 2015;16(2):161-168. doi: 10.1016/S1470-2045(14)71168-4.
13. 13. Xu L, Su X, He Z, et al. Short-term outcomes of complete mesocolic excision versus D2 dissection in patients undergoing laparoscopic colectomy for right colon cancer (RELARC): a randomised, controlled, phase 3, superiority trial. Lancet Oncol. 2021;22(3):391-401. doi: 10.1016/S1470-2045(20)30685-9.
14. 14. Killeen S, Mannion M, Devaney A, Winter DC. Complete mesocolic resection and extended lymphadenectomy for colon cancer: a systematic review. Colorectal Dis. 2014;16(8):577-594. doi: 10.1111/codi.12616.
15. 15. Kontovounisios C, Kinross J, Tan E, Brown G, Rasheed S, Tekkis P. Complete mesocolic excision in colorectal cancer: a systematic review. Colorectal Dis. 2015;17(1):7-16. doi: 10.1111/codi.12793.
16. 16. Willaert W, Ceelen W. Extent of surgery in cancer of the colon: is more better? World J Gastroenterol. 2015;21(1):132- 138. doi: 10.3748/wjg.v21.i1.132.
17. 17. Kong JC, Prabhakaran S, Choy KT, Larach JT, Heriot A, Warrier SK. Oncological reasons for performing a complete mesocolic excision: a systematic review and meta-analysis. ANZ J Surg. 2021;91(1-2):124-131. doi: 10.1111/ans.16518.