Lymphatic Mapping and Lymphatic Endothelial Cell Isolation in Colorectal Cancer Patients

点击翻译按钮获取中文摘要

Background : SLN biopsy has already been established as a common procedure, and its clinical usefulness has been confirmed in patients with malignant lymphoma and breast cancer. In colorectal cancer, however, the application of the SLN theory remains uncommon and its clinical significance is also unclear. In addition, the characteristics of the lymphatic vessels that connect SLNs or the lymphatic endothelial cells have been unclear until now.Methods : SLN biopsy by the subserous dye injection method (patent blue) was conducted in 36 patients with colorectal cancer for which curative resection was possible (stage 0 : 2 cases, stage I : 18 cases, stage II : 4 cases, stage III : 12 cases), with additional systematic lymph node dissection. Endothelial cells were isolated from lymphatic vessels identified at the time of the SLN biopsy by the collagenase II perfusion method, and we tried to transfer them into a culture system with an endothelial cell-specific medium.Results : SLNs could be i … More dentified in 34 cases (94%). The total number of resected lymph nodes was 705, and 72 of those nodes were confirmed as SLNs (10.2%). Ten metastasis-positive nodes were found in SLNs (13.9%), and the mean number of identified SLNs per case was 2.0. The sensitivity to detect metastatic lymph nodes and the specificity of the SLN biopsy for all removed lymph nodes was 86.1% and 99.2%, respectively. No complications or toxicity associated with the dye injection were observed. In addition, cells isolated from removed lymphatic vessels formed colonies with endothelial cell-specific properties, and the expression of lymphatic endothelial cell-specific VEGFR-3 was observed.Conclusion : The SLN biopsy by the dye method for colorectal cancer is a procedure with high sensitivity, accuracy and safety that is applicable to cases with advanced cancer. In addition, a method was established to isolate only lymphatic endothelial cells from resected lymphatic vessels and to culture them. Our results are expected to be another milestone in the determination of the rational margin of resection in colorectal surgery and the future clarification of the mechanism of lymphatic metastasis. Less