Lymphatic mapping and sentinel node analysis to optimize resection and staging of colorectal cancer

ABSTRACT

30 patients with clinically localized colorectal neoplasms or premalignant polyps underwent preoperative submucosal injection of isosuflan blue dyevia colonoscopv. Blue stained lymphatics were visualized during surgery and followed to sentinel lymph node [SLN], which was tagged with black silk sutures. Colectomy was completed in the standard fashion. Postoperatively' all [SLN] were stained by haematoxilin and eosin, and multiple sections of each SLN were examined by immunohistochemical staining using cytokeratin antibody. SLN was identified intraoperatively in all patients. The SLN accurately predicts the tumour status of the nodal basin in 93% of cases. In 8 cases [29%]. an unexpected lymphatic drainage pattern altered the extent of mesenteric resection, and in 4 cases [14%] tumour deposits were identified by immunohistochemical staining and limited to the SLN. This study confirms that SLN mapping can alter the margins of resection and may improve proper staging of tumour and hence adjust the need of post Operative adjuvant therapy and minimize the possibilities of recurrence