M Beisani1, I Roca2, R Cardenas3, L Blanco4, M Abu-Suboh5, J Dot5, J R Armengol5, J J Olsina6, J Balsells4, R Charco4, J Castell3. 1. Department of HPB Surgery, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: mbeisani@gmail.com. 2. Department of Nuclear Medicine, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: isaroca@gmail.com. 3. Department of Nuclear Medicine, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. 4. Department of HPB Surgery, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. 5. Department of Digestive Endoscopy, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. 6. Department of Surgery, Hospital Arnau de Vilanova, University of Lleida, Lleida, Spain.
Abstract
BACKGROUND: The local recurrence of pancreatic cancer is around 30% when complete resection can be achieved. Extended lymphatic resections may improve survival, but increases severe morbidity. As accurate patient selection should be mandatory, a new method is presented for pancreatic sentinel lymph node (SLN) detection with lymphoscintigraphy and gamma probe. MATERIALS AND METHODS: Seven patients with cT2N0M0 pancreatic head cancer were enrolled between 2009 and 2012 in this prospective study. One day prior to surgery, preoperative lymphoscintigraphy with echoendoscopic intratumoural administration of Tc(99m)-labelled nanocolloid was performed, with planar and SPECT-CT images obtained 2h later. Gamma probe detection of SLN was also carried out during surgery. RESULTS: Radiotracer administration was feasible in all patients. Scintigraphy images showed inter-aortocaval lymph nodes in 2 patients, hepatoduodenal ligament lymph nodes in 1, intravascular injection in 3, intestinal transit in 5, and main pancreatic duct visualisation in 1. Surgical resection could only be achieved in 4 patients owing to locally advanced disease. Intraoperative SLN detection was accomplished in 2 patients, both with negative results. Only in one patient could SLN be confirmed as truly negative by final histopathological analysis. CONCLUSIONS: This new method of pancreatic SLN detection is technically feasible, but challenging. Our preliminary results with 7 patients are not sufficient for clinical validation.
BACKGROUND: The local recurrence of pancreatic cancer is around 30% when complete resection can be achieved. Extended lymphatic resections may improve survival, but increases severe morbidity. As accurate patient selection should be mandatory, a new method is presented for pancreatic sentinel lymph node (SLN) detection with lymphoscintigraphy and gamma probe. MATERIALS AND METHODS: Seven patients with cT2N0M0 pancreatic head cancer were enrolled between 2009 and 2012 in this prospective study. One day prior to surgery, preoperative lymphoscintigraphy with echoendoscopic intratumoural administration of Tc(99m)-labelled nanocolloid was performed, with planar and SPECT-CT images obtained 2h later. Gamma probe detection of SLN was also carried out during surgery. RESULTS: Radiotracer administration was feasible in all patients. Scintigraphy images showed inter-aortocaval lymph nodes in 2 patients, hepatoduodenal ligament lymph nodes in 1, intravascular injection in 3, intestinal transit in 5, and main pancreatic duct visualisation in 1. Surgical resection could only be achieved in 4 patients owing to locally advanced disease. Intraoperative SLN detection was accomplished in 2 patients, both with negative results. Only in one patient could SLN be confirmed as truly negative by final histopathological analysis. CONCLUSIONS: This new method of pancreatic SLN detection is technically feasible, but challenging. Our preliminary results with 7 patients are not sufficient for clinical validation.
Authors: Vladimir Sadkin; Viktor Sкuridin; Evgeny Nesterov; Elena Stasyuk; Alexander Rogov; Natalya Varlamova; Roman Zelchan Journal: Sci Rep Date: 2020-08-19 Impact factor: 4.379