Prospective randomized evaluation of preoperative endoscopic vital staining using CH-40 for lymph node dissection in gastric cancer.
BACKGROUND
CH-40 is a suspension of activated carbon particles that was developed in Japan to carry anticancer drugs to regional nodes and peritoneal seedings of gastric cancer.


METHODS
Forty-five consecutive patients who had surgical resection and D2 lymph node dissection for gastric cancer over a 2-year period were randomly assigned to preoperative endoscopic submucosal injection of CH-40 (group A) or no staining (group B). A total of 21 patients in group A and 24 in group B were available for analysis.


RESULTS
The number of resected nodes per patient was significantly higher (t = 6.06; 40 df; P < .0001) in group A (mean+/-S.E. = 35.3+/-1.24) than in group B (mean+/-S.E. = 25.5+/-1.02). The rate of metastatic nodes resected was significantly higher (chi2 = 6.903 ; 1 df; P = .009) in stained (22.5%) than in non-stained (14.7%) nodes of group A and also (chi2 = 6.906; 1 df; P = .009) in stained nodes of group A than in group B (15.8%).


CONCLUSIONS
Preoperative endoscopic vital staining with CH-40 proved to be rapid, safe, and effective in all cases in this series. Its use allowed surgeons to resect a higher number of lymph nodes. and to identify and examine more metastatic nodes. It also permitted identification of nodal micrometastases on routine histopathologic examination.
Catarci
M
M
Division of General Surgery, School of Medicine, University of Rome La Sapienza, Italy.
Guadagni
S
S
Zaraca
F
F
Pistoia
M A
MA
Mastracchio
A
A
Trecca
A
A
Ruco
L
L
Carboni
M
M
D000328:Adult; D000368:Aged; D002244:Carbon; D004396:Coloring Agents; D005260:Female; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D013194:Staining and Labeling; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*
D004396:Coloring Agents; D002244:Carbon