결장직장암에서 체외 감시림프절의 의의
Ex-vivo Sentinel Lymph-node Mapping in Colorectal Cancer
김형진, 이인규, 이윤석, 강원경, 안창혁, 오승택,
소속 상세정보
김형진 ( Kim Hyung Jin )
가톨릭대학교 의과대학 외과학교실
이인규 ( Lee In-Kyu )
가톨릭대학교 의과대학 외과학교실
이윤석 ( Lee Yoon-Suk )
가톨릭대학교 의과대학 외과학교실
강원경 ( Kang Won-Kyung )
가톨릭대학교 의과대학 외과학교실
안창혁 ( An Chang-Hyeok )
가톨릭대학교 의과대학 외과학교실
오승택 ( Oh Seung-Tack )
가톨릭대학교 의과대학 외과학교실
KMID : 0356720080240010039
Abstract
Purpose: The presence of lymph-node metastases is one of the most important prognostic factors for patients with a colorectal carcinoma. The sentinel lymph node is the first lymph node that receives afferent lymphatic drainage from a primary tumor, and thus has the highest risk of harboring metastatic disease.
Methods: Twenty- eight patients with an adenocarcinoma of the colon or the rectum were investigated. After resection of the specimen in standard oncologic fashion, the specimen was dissected longitudinally along the antimesenteric border, and methylene blue was injected around the tumor submucosally. After 5 minutes, the mesentery was meticulously examined, and blue-stained lymphatics and lymph nodes were carefully dissected and harvested.
Results: Sentinel lymph nodes were identified in all cases. The average number of sentinel nodes identified was 3 (range, 1∼6), and the average number of lymph nodes retrieved was 20.8 (range, 6∼42). Of the fifteen patients (53.6%) identified to be positive for lymph-node metastasis 10 showed nonsentinel nodal metastasis without sentinel nodal involvement. No additional isolated tumor cells were found by immunohistochemical staining in 13 patients who had no lymph-node metastasis on conventional pathologic examination.
Conclusions: In colorectal cancer, the sentinel-lymph-node sampling method is easy and can be performed for the purpose of finding lymph nodes easily. However, applying the sentinel-lymph-node sampling method for the purpose of minimizing lymph node dissection, as in breast cancer, is not recommended because of the high probability of missing metastasis.
키워드
결장직장암;감시림프절;체외
Colorectal neoplasm;Sentinel lymph node;Ex-vivo
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