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Randomized Controlled Trial
. 2016 Mar 24:14:88.
doi: 10.1186/s12957-016-0835-3.

Clinical study of harvesting lymph nodes with carbon nanoparticles in advanced gastric cancer: a prospective randomized trial

Ziyu Li  1 , Sheng Ao  1   2 , Zhaode Bu  1 , Aiwen Wu  1 , Xiaojiang Wu  1 , Fei Shan  1 , Xin Ji  1 , Yan Zhang  3 , Zhaodong Xing  1 , Jiafu Ji  4   5
Affiliations
Randomized Controlled Trial

Clinical study of harvesting lymph nodes with carbon nanoparticles in advanced gastric cancer: a prospective randomized trial

Ziyu Li et al. World J Surg Oncol. .

Abstract

Background: The objective of this study is to evaluate the efficiency and safety of carbon nanoparticles (CNPs) for harvesting lymph nodes (LNs) in cases of advanced gastric cancer (AGC).

Methods: Patients with previously untreated resectable AGC were eligible for inclusion in this study. All patients were randomly allocated to two subgroups. In the experimental group, 1.0 mL of CNP was injected into the subserosa of the stomach around the tumor before gastrectomy with D2 dissection. The same procedure was performed directly without any coloring material in the control arm. Following surgery, LNs were harvested, colored LNs were counted, and the diameters were measured by the investigator and pathologist.

Results: Thirty patients were enrolled in the study. We observed no serious adverse effects related to CNP injection. The rate of stained LNs was 46.6%. The mean number of harvested LNs was larger in the experimental than in the control group (38.33 vs 28.27, p = 0.041). A smaller diameter of LNs was recorded in the experimental arm (3.32 vs 4.30 mm, p = 0.023). In addition, we developed a model for predicting the total number of LNs based on the data from CNP-stained LNs and metastatic LNs (MLNs).

Conclusions: CNP is a safe material. Surgeons could harvest more LNs in patients with AGC. The harvest of an increased number of smaller diameters of LNs may be beneficial. Further study is warranted to demonstrate the model's practicality.

Keywords: Advanced gastric cancer; Carbon nanoparticles; D2 gastrectomy; LN harvesting.

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Figures

Fig. 1
Fig. 1
Trial scheme
Fig. 2
Fig. 2
a Carbon nanoparticles were injected into the subserosa of the stomach around the tumor; the arrows show the injection sites. b D2 dissection performed in total gastrectomy; spleen-preserving station no. 10 was resected. SV splenic vessels, PGA posterior gastric artery. c D2 dissection performed in distal gastrectomy; portions of dissected LNs are shown. CHA common hepatic artery, LGA left gastric artery, LGV left gastric vein, RGV right gastric vessels, DS duodenal stump.
Fig. 3
Fig. 3
a Harvested LNs from every patient. b Total number of harvested LNs and metastatic LNs in the experimental and control groups. c Harvested LNs from every station
Fig. 4
Fig. 4
a Mean diameters of LNs in each patient. b Mean diameter of LNs in station no. 3. c Mean diameter of LNs in station no. 1
Fig. 5
Fig. 5
Small LNs were stained by carbon nanoparticles so that they would not be left in case of micrometastases (arrows show the small LNs)
See this image and copyright information in PMC

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