Lymph road mapping obtained via blue sentinel node detection to avoid middle colic artery resection for highly selected colon cancer cases: proof of a concept?
BACKGROUND
In theory, perioperative detection of lymph nodes with the injection of isosulfan blue dye should provide lymph road mapping (LRM) able to direct the resection. However, there is no supporting evidence for this theory in cases of colon cancer. We reanalysed all operative reports using the sentinel lymph node technique with blue dye injection.


METHODS
The retrospective study included 140 patients who underwent the sentinel lymph node (SLN) procedure between February 2001 and November 2007, including 70 cases in which the in vivo technique was used. In 8 cases (11%), LRM was used by the surgeon to determine the extent of resection.


RESULTS
In 5 cases, including limited or extended resection, the final pathological stage was II at the end of the follow-up period, and the patients had no recurrent disease. However, findings for 3 cases of stage III cancer were more relevant to the aims of this study. In these 3 patients, one with cancer (T3N1(3/22)) located at the hepatic flexure, and 2 with cancers (T3N2(7/41) and T2N2 (4/15)) at the splenic flexure, the middle colic artery was conserved as a result of LRM information. Of these 3 patients, 1 was alive without disease at 6-year follow-up and 2 at 5-year follow-up.


CONCLUSIONS
LRM obtained via blue sentinel node detection makes it possible to avoid middle colic artery resection for selected colon cancer cases. LRM seems particularly suitable in cases of colonic flexure location or prior colon surgery.
Lo Dico
R
R
Service de Chirurgie Oncologique, Institut Gustave Roussy, 34 rue Camille Desmoulins, 94805, Villejuif, France.
Lasser
P
P
Goérè
D
D
Malka
D
D
Boige
V
V
Pocard
M
M
D000368:Aged; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods; D003106:Colon / Q000098:blood supply; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery*; D004396:Coloring Agents; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D009367:Neoplasm Staging / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D004396:Coloring Agents; D012394:Rosaniline Dyes; C025484:iso-sulfan blue