Lymphatic Mapping for Sentinel Node Identification and Analysis
Status:
Completed
Trial end date:
2015-10-01
Target enrollment:
Participant gender:
Summary
The main objective of this study is to determine whether the first (sentinel) lymph nodes in
the drainage pathway of colonic tumour can be detected at the time of surgery using a new
technique. The detection method is to inject a fluorescent dye (indocyanine green) adjacent
to the tumour. The dye will then be seen as it fluoresces in the light form the near infrared
spectrum that can be used at the time of the laparoscopic (keyhole) surgery. An endoscope is
placed in the colon (colonoscopy) during surgery and the tracer fluorescent agent is injected
around the tumour. The mesentery in which the lymph nodes draining the tumour are located
will then be examined by laparoscopy as it is expected that fluorescence will be identified
within approximately 5 minutes of the injection. The first lymph node or nodes that take up
the fluorescent dye will then be marked by placing a clip or a stitch by them. After the
surgery has been completed and colon removed all lymph nodes can be examined microscopically
by the pathologist, paying a particular attention to whether any tumour cells are present in
the sentinel lymph nodes and whether the presence or the absence of tumour cells in that node
accurately reflects the tumour status of the rest of the specimen.
If this pilot demonstrates that sentinel lymph nodes can be reliably detected, we have
developed a technique which allows us to remove a small area (less than 5 cm) of the colon.
Using this procedure should decrease complications following traditional surgery. We however
also need a method that allows accurate assessment of the lymph nodes draining the tumour.
This pilot trial will examine our ability to detect such 'sentinel' lymph nodes so that we
can use their status (positive for cancer cells or negative) to determine whether a smaller
operation such as full thickness localised excision is adequate treatment for the patient and
that they can avoid a larger operation.