๐ฆ๐ฒ๐ป๐๐ถ๐ป๐ฒ๐น ๐น๐๐บ๐ฝ๐ต ๐ป๐ผ๐ฑ๐ฒ ๐ฏ๐ถ๐ผ๐ฝ๐๐ ๐ถ๐ป ๐ฐ๐ผ๐น๐ผ๐ฟ๐ฒ๐ฐ๐๐ฎ๐น ๐ฐ๐ฎ๐ป๐ฐ๐ฒ๐ฟ๐:
-Although sentinel lymph node biopsy is a standard procedure for treatment of some malignancies as breast cancer or melanoma, its clinical role is still controversial in colon cancer. Because undetected metastatic lymph nodes can result in understaging and consequently exclusion from the possible benefit of adjuvant chemotherapy, many research are trying to improve surgical and pathologic technic for more precise diagnosis, including sentinel lymph node mapping. It can have a possibility to detect and resect more malignant lymph node or avoid unnecessary extensive resection.
-Currently, endoscopic tattooing with near-infrared fluorescence imaging using indocyanine green improved its visibility during laparoscopic resections.
๐๐ป๐ฑ๐ถ๐ฐ๐ฎ๐๐ถ๐ผ๐ป๐:
In fact, in advanced diseases lymphatic flow may be altered by the closure of lymphatic ducts near the lesion. Therefore SLNB done in patients wit stage I or II disease. These early stage patients are the class of patients that can benefit more from minimally invasive treatment, because the highest number of conversions from laparoscopy to laparotomy are in advanced cancer cases, with invasion of the adjacent structure and in the bulky diseases.
๐ฅ๐ฒ๐ณ๐ฟ๐ฒ๐ป๐ฐ๐ฒ๐:
๐ ๏ธSegura et al. reported 14% of upstaging with ex vivo sentinel lymph node mapping with methylene blue staining in the patients staged as N0 by
conventional technique.
๐ ๏ธPouw et al. demonstrate that ex-vivo magnetic sentinel lymph node mapping is a feasible
technique for use in routine clinical practice, improving nodal staging accuracy of colorectal cancer patients.
๐ ๏ธWeixler et al. performed sentinel lymph node mapping with isosulfan blue and indocyanine green and demonstrated a high diagnostic accuracy to detect isolated tumor cells and micro-metastases of lymph node for both techniques (Fig. 21.3).
๐๐ผ๐ป๐ฐ๐น๐๐๐ถ๐ผ๐ป:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223971/
Laparoscopic lymphatic mapping and SN removal is feasible in laparoscopic colectomy for colon cancer. The ex vivo technique is useful as a salvagetechnique in case of failure of the intra-operative procedure. Prospective studies are justified to determine the real accuracy and false-negative rate of the technique.