Effect of activated carbon nanoparticles on lymph node harvest in patients with colorectal cancer

Abstract

Aim The aim was to examine the effect of activated carbon nanoparticles (ACNs) on lymph node retrieval in colorectal cancer (CRC) patients. Methods This prospective randomized study of 80 subjects was performed between March 2016 and December 2016. Eighty patients with CRC were randomly divided into two groups, the ACN group and a control group. The patients in the ACN group were subjected to 1 ml of ACN injection in the subserosa around the tumour before colectomy and D3 lymphadenectomy. The patients in the control group received the same procedure without the injection of ACNs. After surgery, lymph nodes were isolated, and the greatest dimensions were measured by the same pathologist. Results The average number of lymph nodes harvested from each patient was markedly more in the ACN group (31.3 ± 8.1) than in the control group (21.9 ± 5.3; P < 0.001), and the average number of lymph nodes less than 5 mm in greatest dimension was significantly more in the ACN group (11.9 ± 4.9) than in the control group (4.1 ± 2.4; P < 0.001). The ACN group (15/40) had a higher rate of Stage III patients compared to the control group (6/39; P = 0.026). Besides, the greatest dimension of 32.8% metastatic lymph nodes was less than 5 mm. Conclusion There is significant upstaging following the use of ACNs, which could find more involved nodes. Therefore, ACNs can be used as a tracer to harvest more lymph nodes in CRC patients, with improvement in the accuracy of pathological staging.

<p>Application of Carbon Nanoparticles in Tracing Lymph Nodes and Locating Tumors in Colorectal Cancer: A Concise Review</p>

“…Thirteen studies had reported total and (or) average number of dissected LNs in the CNPs group and the control group, respectively ( Table 3). Eleven of 13 studies showed that the total (and /or) mean number of detected LNs per patient was significantly higher in the CNPs group than in the control group, 23,[26][27][28][29][30][31][32][33][34][35][36] illuminating the superiority of CNPs in tracing LNs. Seven studies recorded the numbers of harvested metastatic LNs, [26][27][28][30][31][32][33][34] wherein two studies found more metastatic LNs in CNPs group, while four studies showed no significant difference between the two groups.…”

“…Eleven of 13 studies showed that the total (and /or) mean number of detected LNs per patient was significantly higher in the CNPs group than in the control group, 23,[26][27][28][29][30][31][32][33][34][35][36] illuminating the superiority of CNPs in tracing LNs. Seven studies recorded the numbers of harvested metastatic LNs, [26][27][28][30][31][32][33][34] wherein two studies found more metastatic LNs in CNPs group, while four studies showed no significant difference between the two groups. Seven studies recorded the patients with metastatic LNs, 23,26,28,[31][32][33][34] three studies detected more LN-positive patients in the CNPs group than in the control group, while four studies showed no significant difference.…”

“…Seven studies recorded the numbers of harvested metastatic LNs, [26][27][28][30][31][32][33][34] wherein two studies found more metastatic LNs in CNPs group, while four studies showed no significant difference between the two groups. Seven studies recorded the patients with metastatic LNs, 23,26,28,[31][32][33][34] three studies detected more LN-positive patients in the CNPs group than in the control group, while four studies showed no significant difference. Six studies had recorded and compared the ratio of patients whose detected LNs were less than 12, 23,26,28,30,32,35 where four of these studies reported a lower ratio of <12 LNs in the CNPs group, 23,26,32,35 while another two studies showed no significant difference.…”

“…Several clinical studies have demonstrated CNPs could be helpful in accurately staging LNs when performing lymphadenectomy, 23,[26][27][28][29][30][31][32][33][34][35][36] resulting in reduced operation time 28,36 as well as less intraoperative blood loss. 24,28,36 Nevertheless, some contradictory studies, which showed that CNPs did not have much advantage either in retrieving LNs or locating tumors, were still reported.…”

“…Two studies underwent submucosal injection surrounding the tumor intraoperatively. 34,39 In another study assessing CNPs' feasibility in advanced CRC, the CNPs detection efficacy was evaluated 8 weeks after chemoradiotherapy (about 14 weeks before surgery). 36 Moreover, there was also study indicated that the time of injection had no significantly relationship with the efficacy of the method.…”