Clinical application of lymph node labeling with Carbon nanoparticles in laparoscopic radical resection for colorectal cancer on the basis of propensity score matching analysis
Abstract:Objective To investigate the clinical application value of preoperative endoscopic localization with carbon nanoparticle suspension in the treatment of colorectal cancer.Methods A retrospective case-control study was performed. Clinicopathological data of colorectal cancer patients who underwent surgery from January 2016 to December 2018 at the First Affiliated Hospital of Nanjing Medical University were collected. A total of 1 343 patients, including 870 males and 473 females, were enrolled in the study. The median age was 63 (range: 17-89) years old. Patients who received endoscopic localization preoperatively by endoscopic carbon nanoparticle tattooing were allocated into the experimental group. Others with no preoperative endoscopic tattoos were allocated to the control group. Eighty-five patients comprised the experimental group, whereas 1 258 patients were in the control group. The observation indicators were as follows: (1)Propensity score matching analysis with patients' general clinicopathological information, including gender, age, body mass index(BMI), and tumor location were compared; (2)The visibility of carbon nanoparticle tattooing in the experimental group was obsered. (3)The number of lymph nodes and positive lymph nodes between the two groups was compared; (4)Follow-up and prognostic analysis were conducted.Results (1) After propensity score matching, 73 patients in the experimental group and 73 patients in the control group with comparable characteristics were identified. Variables, such as age, BMI, tumor morphology, tumor size, T stage, tumor differentiation, and perineural invasion, showed no differences between the two groups (all P values>0.05). (2)All colorectal tumor locations in the experimental group were clearly identified with carbon nanoparticle tattooing. (3) The numbers of lymph nodes harvested in the experimental and control groups were 18 (15, 24) and 16 (14,19), respectively, indicating significant differences between the two groups (Z=-2.909, P<0.05). No difference was found concerning the number of positive lymph nodes harvested between the two groups (Z=-1.045, P>0.05). Univariate analysis and subsequent multivariable Poisson regression showed that tumor location and localization with carbon nanoparticles were significantly associated with the number of lymph nodes (all P values<0.05). (4) A total of 142 patients were followed up with a median time of 25.0 (range: 3.2-47.0) months. The three-year tumor-free survival rate in the experimental group had no significant difference with that of the control group (P>0.05).Conclusions Preoperative endoscopic localization with carbon nanoparticle suspension can assist the identification of tumor location in laparoscopic colorectal cancer surgery. With its lymph node tracing characteristic, carbon nanoparticles can remarkably increase the number of lymph nodes retrieved. Further studies are required to confirm whether carbon nanoparticle suspension can increase the number of positive lymph nodes and improve patients' oncological outcomes.
Letarte F, Webb M, Raval M, et al. Tattooing or not? A review of current practice and outcomes for laparoscopic colonic resection following endoscopy at a tertiary care centre[J]. Can J Surg, 2017, 60(6): 394-398. DOI:10.1503/cjs.004817.
[5]
Saleh F, Abbasi TA, Cleghorn M, et al. Preoperative endoscopy localization error rate in patients with colorectal cancer[J]. Surg Endosc, 2015, 29(9): 2569-2575. DOI:10.1007/s00464-014-3969-9.
[6]
林晨, 张再重, 王烈, 等. 纳米碳染色标记在内镜下切除早期结肠癌后追加外科手术中的病灶定位作用[J]. 中华胃肠外科杂志, 2017, 20(8): 910-913. DOI:10.3760/cma.j.issn.1671-0274.2017.08.018.Lin C, Zhang ZZ, Wang L, et al.Effect of nano carbon tattooing on the lesion localization in the early colon cancer for additional surgical procedure after endoscopic resection[J]. Chin J Gastrointest Surg, 2017, 20(8): 910-913. DOI:10.3760/cma.j.issn.1671-0274.2017.08.018.
Wang Q, Chen E, Cai Y, et al. Preoperative endoscopic localization of colorectal cancer and tracing lymph nodes by using carbon nanoparticles in laparoscopy[J]. World J Surg Oncol, 2016, 14(1): 231. DOI:10.1186/s12957-016-0987-1.
Moss A, Bourke MJ, Pathmanathan N. Safety of colonic tattoo with sterile carbon particle suspension: a proposed guideline with illustrative cases[J]. Gastrointest Endosc, 2011, 74(1): 214-218. DOI:10.1016/j.gie.2011.01.056.
[12]
Yoda Y, Ikematsu H, Matsuda T, et al. A large-scale multicenter study of long-term outcomes after endoscopic resection for submucosal invasive colorectal cancer[J]. Endoscopy, 2013, 45(9): 718-724. DOI:10.1055/s-0033-1344234.
[13]
Lee J, Little TD. A practical guide to propensity score analysis for applied clinical research[J]. Behav Res Ther, 2017, 98: 76-90. DOI:10.1016/j.brat.2017.01.005.
[14]
葛洁, 颜博, 曹旭晨. 纳米炭混悬注射液与亚甲蓝注射液在早中期乳腺癌前哨淋巴结活检中的应用[J]. 中华肿瘤杂志, 2011, 33(3): 226-228. DOI:10.3760/cma.j.issn.0253-3766.2011.03.016.Ge J, Yan B, Cao XC.Comparison of sentinel lymph node detection by methylene blue and carbon nanoparticle suspension injection in early breast cancer[J]. Chin J Oncol, 2011, 33(3): 226-228. DOI:10.3760/cma.j.issn.0253-3766.2011.03.016.
[15]
杨斌, 李英儒, 温润龙, 等. 纳米碳淋巴示踪技术应用于腹腔镜结直肠癌根治术的意义[J]. 中华胃肠外科杂志, 2015, 18(6): 549-552. DOI:10.3760/cma.j.issn.1671-0274.2015.06.009.Yang B, Li YR, Wen RL, et al. Application of carbon nanoparticles labeled lymph node staining in curative laparoscopic resection for colorectal carcinoma[J].Chin J Gastrointest Surg, 2015, 18(6): 549-552. DOI:10.3760/cma.j.issn.1671-0274.2015.06.009.
[16]
张相春, 王延磊, 晏伟, 等. 纳米碳淋巴示踪剂在腹腔镜结直肠癌手术中的应用探讨[J]. 中华医学杂志, 2015, 95(32): 2612-2615. DOI:10.3760/cma.j.issn.0376-2491.2015.32.009.Zhang XC, Wang YL, Yan W, el al. Application of lymph node labeling with carbon nanoparticles in laparoscopic colorectal cancer surgery[J]. Natl Med J Chin, 2015, 95(32): 2612-2615. DOI:10.3760/cma.j.issn.0376-2491.2015.32.009.
[17]
赵磊, 刘春庆, 刘建, 等. 纳米碳在腹腔镜直肠癌根治术中应用效果评价[J]. 中华结直肠疾病电子杂志, 2018, 7(5): 442-446. DOI:10.3877/cma.j.issn.2095-3224.2018.05.007.Zhao L, Liu CQ, Liu J, et al.The evaluation of application of carbon nanoparticles in laparoscopic radical resection for rectal cancer[J]. Chin J Colorec Dis(Electronic Edition), 2018, 7(5): 442-446. DOI:10.3877/cma.j.issn.2095-3224.2018.05.007.
[18]
Yan J, Xue F, Chen H, et al. A multi-center study of using carbon nanoparticles to track lymph node metastasis in T1-2 colorectal cancer[J]. Surg Endosc, 2014, 28(12): 3315-3321. DOI:10.1007/s00464-014-3608-5.
[19]
Bartels SA, van der Zaag ES, Dekker E, et al. The effect of colonoscopic tattooing on lymph node retrieval and sentinel lymph node mapping[J]. Gastrointest Endosc, 2012, 76(4): 793-800. DOI:10.1016/j.gie.2012.05.005.