Fluorescence-guided mesorectal nodes harvesting associated with local excision for early rectal cancer: technical notes.

IF 1.7 4区 医学 Q2 SURGERY
Ilaria Benzoni, Martina Fricano, Jessica Borali, Martina Bonafede, Andrea Celotti, Antonio Tarasconi, Valerio Ranieri, Luigi Totaro, Luca Mattia Quarti, Arianna Dendena, Giulia Grizzi, Maria Bonomi, Roberto Grassia, Barbara Frittoli, Gian Luca Baiocchi
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引用次数: 0

Abstract

Background: The spread of colorectal cancer screening has increased the percentage of patients with early-stage rectal cancer; at least 30% of patients are diagnosed with a clinical-stage cT1 or pT1 after endoscopic excision. In this subgroup of patients, the real advantage of total mesorectal excision (TME) over local excision (LE) is the ability to remove mesorectal nodes, which are metastatic in less than 20% of cases.

Method: To solve the unmet need for accurate nodal staging in patients with cT0/cT1, cN0 rectal cancer, we designed a pilot study that associates LE with mesorectal fluorescence-guided nodal sampling. From November 2018 to November 2023, we enrolled a total of ten patients with T1N0M0 rectal cancer. After extensive staging and adequate information, patients underwent endoscopic indocyanine green (ICG) infiltration and transanal local excision associated with laparoscopic fluorescence-guided mesorectal nodal sampling.

Results: After a median follow-up of 24 months (range 1-63 months), no case of local or nodal recurrence was observed. All patients were spared from ostomy and lower anterior resection syndrome.

Conclusions: In selected cases of cT0-1cN0 rectal cancer, transanal local excision plus ICG lymph nodal sampling is a feasible surgical option that increases the rate of organ preservation. Further studies are needed to identify the patients most likely to benefit from this minimally invasive strategy.

荧光引导下与早期直肠癌局部切除术相关的直肠系膜结节摘除术:技术说明。
背景:结直肠癌筛查的普及增加了早期直肠癌患者的比例;至少30%的患者在内镜切除后被诊断为临床期cT1或pT1。在这一亚组患者中,全肠系膜切除术(TME)相对于局部切除术(LE)的真正优势在于能够切除肠系膜淋巴结,其中只有不到20%的病例发生转移。方法:为了解决cT0/cT1, cN0直肠癌患者对准确淋巴结分期的需求,我们设计了一项将LE与肠系膜荧光引导淋巴结取样相关联的初步研究。从2018年11月至2023年11月,我们共入组了10例T1N0M0直肠癌患者。在广泛的分期和充分的信息后,患者接受内镜下吲哚菁绿(ICG)浸润和经肛门局部切除,并结合腹腔镜荧光引导的肠系膜结取样。结果:中位随访24个月(1-63个月),未见局部或淋巴结复发。所有患者均未出现造口术和下前切除术综合征。结论:在选定的cT0-1cN0直肠癌病例中,经肛门局部切除加ICG淋巴结取样是一种可行的手术选择,可提高器官保存率。需要进一步的研究来确定最有可能从这种微创策略中获益的患者。
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来源期刊
CiteScore
3.80
自引率
5.90%
发文量
39
审稿时长
6-12 weeks
期刊介绍: Minimally Invasive Therapy and Allied Technologies (MITAT) is an international forum for endoscopic surgeons, interventional radiologists and industrial instrument manufacturers. It is the official journal of the Society for Medical Innovation and Technology (SMIT) whose membership includes representatives from a broad spectrum of medical specialities, instrument manufacturing and research. The journal brings the latest developments and innovations in minimally invasive therapy to its readers. What makes Minimally Invasive Therapy and Allied Technologies unique is that we publish one or two special issues each year, which are devoted to a specific theme. Key topics covered by the journal include: interventional radiology, endoscopic surgery, imaging technology, manipulators and robotics for surgery and education and training for MIS.
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