Use of Navigator for Intraoperative Detection of Lymph Node Metastases for Colorectal Carcinoma During Laparoscopic Surgery

Nobuyoshi Miyajima, Katsuyuki Takahashi and Tatsuo Yamakawa

Department of Surgery, Teikyo University Hospital, Mizonokuchi

Intraoperative detection of lymph node metastases of colorectal carcinoma was attempted with 67-Ga citrate and Navigator. 67-Ga citrate was injected intravenously in 10 patients with colorectal carcinoma 96 hours before surgery. Immediately after the surgical specimens were resected, the lymph nodes were divided and gamma ray intensity was counted with Navigator and a hand-held detector probe. A total of 157 lymph nodes were resected. Histopathological examination revealed that 137 of them were metastasis-negative and the remaining 20 were positive. The intensity of the gamma energy of each lymph node/background ratio (L/B ratio) was calculated and the cut-off value was determined to be 2.0. The L/B ratio of all metastasis-positive lymph nodes was over 2.0, and 97.2% of metastasis-negative lymph nodes could be identified. Based on these findings, intraoperative lymph node metastasis was detected in 10 cases of colorectal carcinoma in which laparoscopic surgery was performed. Before lymphadenectomy, the marginal vessels on both the proximal and the distal side of the tumor, the feeding artery, and the drainage vein were clamped. The gamma-detecting probe was then applied just along the tumor and the regional lymph nodes. Metastasis to the lymph nodes could be predicted in every case. In conclusion, detection of lymph node metastasis with 67-Ga citrate and Navigator is very useful in choosing the operative method and the range of lymphadenectomy, especially in laparoscopic colorectal surgery in which palpation is impossible.

Key words
lymph node navigator, colorectal carcinoma, lymph node metastasis, laparoscopic surgery,⁶⁷Ga citrate

Reprint requests
Nobuyoshi Miyajima Department of Surgery, Teikyo University Hospital, Mizonokuchi3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, 213-8507 JAPAN

Accepted
March 22, 2000

To read the PDF file you will need Abobe Reader installed on your computer.