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Sentinel lymph node rectal cancer

Stelian ŞtefăniŢă Mogoantă, Firmilian Calotă, Ion Vasile, Antoanela Valentina Crafciuc, Mircea Constantin Gherghinescu, Konstantinos Sapalidis, Daniel Sorin Ilie, Daniela Adriana Ion
Colorectal cancer is currently one of the most common malignancies in both men and women. Surgical resection remains the essential element in the local control of the disease but the development of novel diagnostic and therapeutic tools can enhance the results of radical surgery. The indication for adjuvant treatment majorly depends on a correct pathological assessment of the surgical specimen - a correct pTNM staging. For patients diagnosed with stage III disease (characterized by the presence of lymph node metastases), adjuvant chemotherapy increases the survival rate, while in stage II disease, in most cases, the chemotherapy is contraindicated, due to increase morbidity without real benefit...
2016: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
Han Bao, Fengjuan Yang, Shaofei Su, Xinyu Wang, Meiqi Zhang, Yaming Xiao, Hao Jiang, Jiaying Wang, Meina Liu
PURPOSE: Substantial gaps exist between clinical practice and evidence-based cancer care, potentially leading to adverse clinical outcomes and decreased quality of life for cancer patients. This study aimed to evaluate the usefulness of clinical pathways as a tool for improving quality of cancer care, using breast, colon, and rectal cancer pathways as demonstrations. METHODS: Newly diagnosed patients with invasive breast, colon, and rectal cancer were enrolled as pre-pathway groups, while patients with the same diagnoses treated according to clinical pathways were recruited for post-pathway groups...
May 2016: Journal of Cancer Research and Clinical Oncology
Paul Sargos, Stéphane Guerif, Igor Latorzeff, Christophe Hennequin, Pascal Pommier, Jean-Léon Lagrange, Gilles Créhange, Olivier Chapet, Renaud de Crevoisier, David Azria, Stéphane Supiot, Muriel Habibian, Michel Soulié, Pierre Richaud
PURPOSE: Recommendations for pelvic lymph node (LN) contouring rely on relatively dated studies that defined the Clinical Target Volume (CTV) of interest proposed for radiotherapy. The aim of this article was to review these recommendations with a critical analysis of published data on prostate cancer drainage. METHODS: We performed a review of data on LN drainage in prostate cancer, based on anatomy texts and studies on lymphography, pelvic LN dissections, sentinel LN techniques, magnetic resonance imaging, computed tomography and functional imaging...
December 2015: Cancer Treatment Reviews
Grace Clara Lee, Patricia Sylla
Since the advent of laparoscopy, minimally invasive techniques such as single port laparoscopy, robotics, endoscopically assisted laparoscopy, and transanal endoscopic surgery continue to revolutionize the field of colorectal surgery. Transanal natural orifice transluminal endoscopic surgery (NOTES) represents a further paradigm shift by combining the advantages of these earlier techniques to reduce the size and number of abdominal incisions and potentially optimize rectal dissection, especially with respect to performance of an oncologically adequate total mesorectal excision (TME) for rectal cancer...
September 2015: Clinics in Colon and Rectal Surgery
Hidejiro Kawahara, Kazuhiro Watanabe, Hiroya Enomoto, Mitsuhiro Tomoda, Tadashi Akiba, Katsuhiko Yanaga
BACKGROUND: Lateral pelvic lymph node metastasis is generally present in 17% of patients with T3 lower rectal cancer. However, such lymph node metastases cannot be accurately detected before surgery. Since 2001, we have performed sentinel node navigation surgery for patients with T3 lower rectal cancer considering the lymph nodes located between the vesicohypogastric fascia and the pelvic nerve plexus as the lateral sentinel lymph node (LSN). PATIENTS AND METHODS: Between 2001 and 2010, 101 patients with T3 lower rectal cancer without distant metastasis or peritoneal dissemination were prospectively enrolled in the study...
June 2015: Anticancer Research
Henricus J M Handgraaf, Leonora S F Boogerd, Floris P R Verbeek, Quirijn R J G Tummers, James C H Hardwick, Coen I M Baeten, John V Frangioni, Cornelis J H van de Velde, Alexander L Vahrmeijer
Tumor involvement at the resection margin remains the most important predictor for local recurrence in patients with rectal cancer. A careful description of tumor localization is therefore essential. Currently, endoscopic tattooing with ink is customary, but visibility during laparoscopic resections is limited. Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) could be an improvement. In addition to localize tumors, ICG can also be used to identify sentinel lymph nodes (SLNs). The feasibility of this new technique was explored in five patients undergoing laparoscopic low anterior resection for rectal cancer...
2016: Minimally Invasive Therapy & Allied Technologies: MITAT
Andrea Morlino, Giuseppe La Torre, Giulia Vitagliano, Aldo Cammarota
AIM: The aim of this study was to report a case concerning diagnostic and management of Anorectal melanoma. MATERIAL: A 71 years old white man presented in our Institute with anal pain, tenesmus, blooding rectal during the last five months. The ano-rectal examination showed a brownish painful mass in the anal canal. The colonscopy and endoscopy showed a big stenotic mass from anal canal to medium rectum with a diameter of approximately 90 mm. RESULTS: Biopsy of the rectal mass was performed and the histopatological examination showed malignant ephitelioid cells, pigmented melanoma...
2015: Annali Italiani di Chirurgia
Satoru Kikuchi, Hiroyuki Kishimoto, Hiroshi Tazawa, Yuuri Hashimoto, Shinji Kuroda, Masahiko Nishizaki, Takeshi Nagasaka, Yasuhiro Shirakawa, Shunsuke Kagawa, Yasuo Urata, Robert M Hoffman, Toshiyoshi Fujiwara
Currently, early gastrointestinal cancers are treated endoscopically, as long as there are no lymph node metastases. However, once a gastrointestinal cancer invades the submucosal layer, the lymph node metastatic rate rises to higher than 10%. Therefore, surgery is still the gold standard to remove regional lymph nodes containing possible metastases. Here, to avoid prophylactic surgery, we propose a less-invasive biological ablation of lymph node metastasis in submucosally invaded gastrointestinal cancer patients...
March 2015: Molecular Therapy: the Journal of the American Society of Gene Therapy
Hansjörg Vees, Giovanna Dipasquale, Philippe Nouet, Thomas Zilli, Luca Cozzi, Raymond Miralbell
We aimed to assess the dosimetric impact of advanced delivery radiotherapy techniques using either intensity modulated x-ray beams (IMXT), volumetric modulated arc therapy (VMAT), or intensity modulated proton therapy (IMPT), for high-risk prostate cancer patients with sentinel nodes in the pararectal region. Twenty high-risk prostate cancer patients were included in a prospective trial evaluating sentinel nodes on pelvic SPECT acquisition. To be eligible for the dosimetric study, patients had to present with pararectal sentinel nodes usually not included in the clinical target volume encompassing the pelvic lymph nodes...
April 2015: Technology in Cancer Research & Treatment
M Fung-Kee-Fung, R P Boushey, J Watters, R Morash, J Smylie, C Morash, C Degrasse, S Sundaresan
BACKGROUND: Patients requiring assessment for cancer surgery encounter a complex series of steps in their cancer journey. Further complicating the process is the fact that care is often delivered in a fragmented, silo-based system. Isolated strategies to improve cancer outcomes within those systems have had inconsistent results. METHODS: A regional quality improvement collaborative was developed based on a community of practice (cop) platform, a hub-and-spoke infrastructure, and a regional steering committee linking cop improvement projects with affiliated hospitals and their strategic priorities...
February 2014: Current Oncology
E Farinella, L Viganò, M C Fava, M Mineccia, F Bertolino, L Capussotti
PURPOSE: The lymph node status is one of the strongest prognostic determinants in rectal cancers. After chemoradiotherapy (CRT), lymph nodes are difficult to detect. This study aims to evaluate the feasibility of lymph node mapping in the mesorectum after CRT to analyze the pattern of metastasis spread and to assess the reliability of blue dye injection in sentinel lymph node detection. METHOD: Ten patients with cN+ mid/low RCs after CRT were prospectively enrolled...
November 2013: International Journal of Colorectal Disease
Luc A Heijnen, Doenja M J Lambregts, Dipanjali Mondal, Milou H Martens, Robert G Riedl, Geerard L Beets, Regina G H Beets-Tan
OBJECTIVES: To evaluate the performance of diffusion-weighted MRI (DWI) for the detection of lymph nodes and for differentiating between benign and metastatic nodes during primary rectal cancer staging. METHODS: Twenty-one patients underwent 1.5-T MRI followed by surgery (± preoperative 5 × 5 Gy). Imaging consisted of T2-weighted MRI, DWI (b0, 500, 1000), and 3DT1-weighted MRI with 1-mm isotropic voxels. The latter was used for accurate detection and per lesion histological validation of nodes...
December 2013: European Radiology
Emanuele Lezoche, Bernardina Fabiani, Giancarlo D'Ambrosio, Pietro Ursi, Andrea Balla, Giovanni Lezoche, Francesco Monteleone, Alessandro M Paganini
BACKGROUND: Endoluminal locoregional resection (ELRR) by transanal endoscopic microsurgery (TEM) is an alternative treatment option for T1N0 rectal cancer and for selected patients with small T2N0 rectal cancer after neoadjuvant radiochemotherapy (n-RCT). The N parameter may remain undefined after transanal surgery. This study aimed to evaluate the role of a modified sentinel lymph node technique to improve N staging that the authors named "nucleotide-guided mesorectal excision" (NGME)...
November 2013: Surgical Endoscopy
Alberto Arezzo, Simone Arolfo, Massimiliano Mistrangelo, Baudolino Mussa, Paola Cassoni, Mario Morino
BACKGROUND: Local excision of invasive cancer by transanal endoscopic microsurgery (TEM) entails the risk of lymphnode metastases that obliges to radical surgery. A determination of metastatic lymph-nodes would avoid major surgery in the vast majority of cases. We applied the concept of sentinel lymphnode (SLN) biopsy to suspected invasive rectal cancers treated by TEM. METHODS: Indocyanine green (ICG) is injected in the submucosa underneath the lesion. The tumor is dissected full-thickness until the perirectal fat...
January 2014: Minimally Invasive Therapy & Allied Technologies: MITAT
Michio Asano
Endoscopic submucosal dissection (ESD) is widely used in Japan as a minimally invasive treatment for early gastric cancer. The application of ESD has expanded to the esophagus and colorectum. The indication criteria for endoscopic resection (ER) are established for each organ in Japan. Additional treatment, including surgery with lymph node dissection, is recommended when pathological examinations of resected specimens do not meet the criteria. Repeat ER for locally recurrent gastrointestinal tumors may be difficult because of submucosal fibrosis, and surgical resection is required in these cases...
October 16, 2012: World Journal of Gastrointestinal Endoscopy
Hong-Ke Cai, Hai-Fei He, Wei Tian, Mei-Qi Zhou, Yue Hu, Yong-Chuan Deng
AIM: To investigate whether activated carbon nanoparticles suspension (ACNS) or methylene blue (MB) can increase the detected number of lymph nodes in colorectal cancer. METHODS: Sixty-seven of 72 colorectal cancer patients treated at our hospital fulfilled the inclusion criteria of the study which was conducted from December 2010 to February 2012. Seven patients refused to participate. Eventually, 60 patients were included, and randomly assigned to three groups (20 in each group): ACNS group (group A), MB group (group B) and non-stained conventional surgical group (group C)...
November 14, 2012: World Journal of Gastroenterology: WJG
Harold J Wanebo, Mark LeGolvan, Philip B Paty, Sukamal Saha, Markus Zuber, Michael I D'Angelica, Nancey E Kemeny
An overview of colorectal cancer discussed (Philip Paty) the good outcome after primary management with local control in 90-95 % of colon and 85 % in rectal cancer patients with major progression to metastases and to death related to hematogenous dissemination. The major disease pathways include the APC, aneuploid pathway involving mutations of P53, KRAS, SMAD 4, or the CMP/MSI pathway, mismatched repair defect as characterized by Lynch syndrome, the major hereditary form which may also have KRAS and P53 mutations...
October 2012: Clinical & Experimental Metastasis
Xiutian Guo, Cun Wang, Xiao-Gang Shen, Si-Qin Ding, Yong-Yang Yu, Zong-Guang Zhou
The aim of the present study to evaluate the application of sentinel lymph node (SLN) pathology in rectal cancer using ex vivo mapping and to investigate the incidence and prognostic value of occult SLN metastasis in routine node-negative specimens. Specimens (n=117) of rectal cancer were examined using a combination of routine pathology and ex vivo SLN mapping. The inspected SLNs were further treated with immunohistochemical staining for occult cancer foci. The log-rank test was used to assess survival. SLNs were examined in 112 of the included specimens with a total number of 212, resulting in an identification rate of 95...
February 2012: Oncology Letters
Edwin S van der Zaag, Wim H Bouma, Pieter J Tanis, Dirk T Ubbink, Willem A Bemelman, Christianne J Buskens
BACKGROUND: The clinical impact of sentinel lymph node (SN) biopsy in colorectal cancer is still controversial. The aim of our study was to determine the accuracy of this procedure from published data and to identify factors that contribute to the conflicting reports. METHODS: A systematic search of the Medline, Embase, and Cochrane databases up to July 2011 revealed 98 potentially eligible studies, of which 57 were analyzed including 3,934 patients (3,944 specimens)...
October 2012: Annals of Surgical Oncology
Massimiliano Mistrangelo, Ettore Pelosi, Marilena Bellò, Umberto Ricardi, Enrica Milanesi, Paola Cassoni, Massimo Baccega, Claudia Filippini, Patrizia Racca, Adriana Lesca, Fernando H Munoz, Gianluca Fora, Andrea Skanjeti, Francesca Cravero, Mario Morino
PURPOSE: Pre- and post-treatment staging of anal cancer are often inaccurate. The role of positron emission tomograpy-computed tomography (PET-CT) in anal cancer is yet to be defined. The aim of the study was to compare PET-CT with CT scan, sentinel node biopsy results of inguinal lymph nodes, and anal biopsy results in staging and in follow-up of anal cancer. METHODS AND MATERIALS: Fifty-three consecutive patients diagnosed with anal cancer underwent PET-CT. Results were compared with computed tomography (CT), performed in 40 patients, and with sentinel node biopsy (SNB) (41 patients) at pretreatment workup...
September 1, 2012: International Journal of Radiation Oncology, Biology, Physics
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