Modified methylene blue injection improves lymph node harvest in rectal cancer

Abstract

The modified method with methylene blue injection improved lymph node harvest in rectal cancer, especially small node and metastatic node retrieval, which provided more accurate staging. However, it was not associated with overall survival.

Methylene blue intra-arterial staining of resected colorectal cancer specimens improves accuracy of nodal staging: A randomized controlled trial

“…The median number of small-diameter (≤ 4 mm) lymph nodes was 20.5 (95% CI 17-23) in the intervention group and 10 (95% CI [9][10][11][12] in the control group (p<0.001). The number of large-diameter (>4 mm) lymph nodes was similar in both groups ( Figure 1).…”

“…In the subgroup analysis of rectal cancer patients who received neoadjuvant radiotherapy or radiochemotherapy, median lymph node count was 16 (95% CI [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] in the intervention group and 11 (95% CI 9-15) in the control group (p=0.1). The median number of smalldiameter (≤ 4 mm) lymph nodes was 14 (95% CI [10][11][12][13][14][15][16][17][18][19] in the intervention group and 9 (95% CI 7-12) in the control group (p=0.02).…”

“…The median number of smalldiameter (≤ 4 mm) lymph nodes was 14 (95% CI [10][11][12][13][14][15][16][17][18][19] in the intervention group and 9 (95% CI 7-12) in the control group (p=0.02). The difference between proportion of patients in whom ≥ 12 lymph nodes were examined was not statistically significant between the groups (Table 3).…”

“…We found six randomized trials assessing the effect of methylene blue staining in the literature (9)(10)(11)(12)(13)(14). All these authors conclude that methylene blue staining increases lymph node count significantly.…”

“…Since then several studies have confirmed this finding (9)(10)(11)(12)(13)(14). However, the method is still not widely recognised and has not been incorporated into routine practice.…”