PDF(Pubmed)
Abstract：
OBJECTIVE: Tattoo markings are often used as preoperative markers for colorectal cancer. However, scattered ink markings adversely affect tumor site recognition intraoperatively; therefore, interventions for rectal cancer may lead to an inaccurate distal resection margin (DRM) and incomplete total mesorectal excision (TME). This is the first case series of fluorescence-guided robotic rectal surgery in which near-infrared fluorescence clips (NIRFCs) were used to localize rectal cancer lesions.
METHODS: We enrolled 20 consecutive patients who underwent robotic surgery for rectal cancer between December 2022 and December 2023 in the current study. The primary endpoints were the rate of intraoperative clip detection and its usefulness for marking the tumor site. Secondary endpoints were oncological assessments, including DRM and the number of lymph nodes.
RESULTS: Clip locations were confirmed in 17 of 20 (85%) patients. NIRFCs were not detected in 3 out of 7 patients who underwent preoperative chemoradiation therapy. No adverse events, including bleeding or perforation, were observed at the time of clipping, and no clips were lost. The median DRM was 55 mm (range, 22-86 mm) for rectosigmoid (Rs), 33 mm (range, 16-60 mm) for upper rectum (Ra), and 20 mm (range, 17-30 mm) for low rectum (Rb). The median number of lymph nodes was 13 (range, 10-21).
CONCLUSIONS: The rate of intraoperative clip detection, oncological assessment, including DRM, and the number of lymph nodes indicate that the utility of fluorescence-guided methods with NIRFCs is feasible for rectal cancer.
METHODS: We enrolled 20 consecutive patients who underwent robotic surgery for rectal cancer between December 2022 and December 2023 in the current study. The primary endpoints were the rate of intraoperative clip detection and its usefulness for marking the tumor site. Secondary endpoints were oncological assessments, including DRM and the number of lymph nodes.
RESULTS: Clip locations were confirmed in 17 of 20 (85%) patients. NIRFCs were not detected in 3 out of 7 patients who underwent preoperative chemoradiation therapy. No adverse events, including bleeding or perforation, were observed at the time of clipping, and no clips were lost. The median DRM was 55 mm (range, 22-86 mm) for rectosigmoid (Rs), 33 mm (range, 16-60 mm) for upper rectum (Ra), and 20 mm (range, 17-30 mm) for low rectum (Rb). The median number of lymph nodes was 13 (range, 10-21).
CONCLUSIONS: The rate of intraoperative clip detection, oncological assessment, including DRM, and the number of lymph nodes indicate that the utility of fluorescence-guided methods with NIRFCs is feasible for rectal cancer.
摘要：
目的：纹身标记通常用作结直肠癌的术前标志物。然而,分散的墨迹会在术中对肿瘤部位识别产生不利影响；因此，直肠癌的介入治疗可能导致远端切缘不准确(DRM)和全直肠系膜切除术(TME)不完全.这是荧光引导机器人直肠手术的第一个案例系列，其中使用近红外荧光夹（NIRFCs）定位直肠癌病变。
方法：在本研究中，我们招募了20名在2022年12月至2023年12月期间接受直肠癌机器人手术的连续患者。主要终点是术中夹检测率及其对标记肿瘤部位的有用性。次要终点是肿瘤学评估，包括DRM和淋巴结的数量。
结果：在20名患者中有17名（85%）患者中确认了夹片位置。在接受术前放化疗的7例患者中，有3例未检测到NIRFCs。无不良事件,包括出血或穿孔，在剪切时观察到，没有剪辑丢失。DRM中位数为55毫米(范围，22-86毫米）用于直肠乙状结肠（Rs），33毫米(范围,16-60毫米）用于上直肠（Ra），和20毫米(范围，17-30毫米）用于低直肠（Rb）。淋巴结的中位数为13（范围，10-21).
结论：术中夹检测率，肿瘤评估,包括DRM,和淋巴结的数量表明，利用NIRFCs的荧光引导方法对直肠癌是可行的。
方法：在本研究中，我们招募了20名在2022年12月至2023年12月期间接受直肠癌机器人手术的连续患者。主要终点是术中夹检测率及其对标记肿瘤部位的有用性。次要终点是肿瘤学评估，包括DRM和淋巴结的数量。
结果：在20名患者中有17名（85%）患者中确认了夹片位置。在接受术前放化疗的7例患者中，有3例未检测到NIRFCs。无不良事件,包括出血或穿孔，在剪切时观察到，没有剪辑丢失。DRM中位数为55毫米(范围，22-86毫米）用于直肠乙状结肠（Rs），33毫米(范围,16-60毫米）用于上直肠（Ra），和20毫米(范围，17-30毫米）用于低直肠（Rb）。淋巴结的中位数为13（范围，10-21).
结论：术中夹检测率，肿瘤评估,包括DRM,和淋巴结的数量表明，利用NIRFCs的荧光引导方法对直肠癌是可行的。
