Regional Lymph Nodes Distribution Pattern in Central Area of Right-sided Colon Cancer: In-Vivo Detection and the Update on the Clinical Exploration.

Abstract

BackgroundDistribution of regional lymph nodes (LNs) is decisive for the lymphadenectomy boundary in radical resection of a right-sided colon cancer (RCC). Currently, the data of LNs in central area remains ambiguous and scarce. Herein we aim to provide a more detailed anatomical research on LNs surrounding the superior mesenteric vessels for RCC and investigated the metastasis rate.MethodsCarbon Nanoparticles (CNs) or Indocyanine Green (ICG) were used as dye and we laparoscopically observed the stained LNs distribution pattern and analyzed the harvested LNs combined with pathology report. Lastly, 137 RCC patients who received a “superior mesenteric artery (SMA)-oriented” hemicolectomy from September 2016 to September 2020 were included to calculate the probability of LNs metastasis in our target area.Results20 patients diagnosed as RCC (mean age 55.55 years, 13 male) were included. 13 patients underwent CNs injection and 7 patients consented to the ICG, while 4 cases suffered from imaging failure. The unequal number of the regional LNs located between SMV and SMA was detected in 17 cases (85%), posterior to SMV area in 6 cases (30%), and anterior to SMA in 11 cases (55%), respectively. The presence of LNs posterior to SMV was associated with the crossing pattern of ileocolic artery (²= 5.38, p= 0.020). The probability of LNs metastasis in the above areas (target areas) was 2.19% (3/137). No dyed LNs occurred when the SMA sheath was exposed. What’s more, the number of total harvested LNs in patients with dye injection was significant more than dye-free RCC patients (22.44±13.78 vs 43.20±22.70, p<0.01). ConclusionRight-hemi colon-draining lymphatic vessels anteriorly/posteriorly traversed the SMV and arrived at the surface of SMA near the middle colonic artery (MCA) level, which highlights the potential need of CME to place the internal border anterior to SMA and the removal of mesenteric tissue in our target area on lymphatic resection.

Novel nomogram for predicting risk of early postoperative small bowel obstruction after right colectomy for cancer

“…However, the dissection of lymph nodes on the SMA surface led to severe chylous ascites. Moreover, previous studies have shown that lymph node dissection damages autonomic nerves and leads to gastrointestinal dysfunction [ 10 ]. In clinical practice, we found a high incidence of chylous ascites after right colectomy; After completing this manuscript, we studied the risk factors of chylous ascites with curiosity and published it before the acceptance of this article [ 24 ].…”

“…Different surgical methods and surgical ranges for right colon cancer have been used, and these have led to different incidences of postoperative complications, including complete mesocolic excision (CME) and D3 lymph node dissection, standard operation and extended right colectomy, and differences in the medial boundary of lymph node dissection [9][10][11]. Currently, few studies on risk factors for EPSBO after right hemicolectomy have been reported, especially to establish predictive models.…”

Risk factors of central area lymph nodes metastasis for guiding optimal right colon cancer surgery: A retrospective multicenter study

“…According to existing research, age, tumor location, tumor size and T stage had been shown to affect LNM in colorectal cancer 17,29,30 Cancer risk communication in sensitivity and speci city for preoperative N stage remains di cult when compared to T stage because differentiating between malignant and reactive lymph node enlargement is di cult 34 . Therefore, studies have aimed at improving the detection rate for positive lymph nodes [35][36][37] .…”

A Novel Nanoprobe for Targeted Imaging and Photothermal/Photodynamic Therapy of Lung Cancer

“…It is a favorable fluorescence nanoprobe owing to its strong near-infrared (NIR) fluorescence emission and optimal photothermal capabilities . Thus, it can be potentially used in the photothermal and photodynamic tumor therapies . However, its diagnostic and therapeutic applications are seriously impeded by its limitations, viz., aggregation and decomposition in the polar solvents, instability in the aqueous solutions, rapid clearance in the plasma medium (half-life: 2–4 min), poor tumor-targeting ability, etc .…”

“…9 Thus, it can be potentially used in the photothermal and photodynamic tumor therapies. 10 However, its diagnostic and therapeutic applications are seriously impeded by its limitations, viz., aggregation and decomposition in the polar solvents, instability in the aqueous solutions, rapid clearance in the plasma medium (half-life: 2−4 min), poor tumor-targeting ability, etc. 11 Therefore, a smart design of the ICG-loaded system is urgently needed for the targeted delivery of ICG during the light-activated combination cancer therapy.…”