McLaren Regional Medical Center, Michigan State Un
Sukamal Saha , Alpesh Korant , Benjamin Abadeer , Andrew Gomez-Seoane , Mohammed Shaik , Madhumitha Krishnamoorthy , Sunil Kaushal , B. K. Ganatra , David Wiese
Background: SLNM in CCa has been established as an aid to the pathologist to identify the nodes most likely to harbor micrometastasis. The technique has been well- established by in vivo and ex vivo technique. No such technique has been described by DRS in CCa. Hence, a pilot study was undertaken to identify if SLNM can be performed by DRS during robotically assisted colectomy as in open cases. Methods: Patients (Pts) with CCa were randomly selected for either robotic or open surgery. During each case, 1% methylene blue dye was injected in vivo subserosally around the tumor. Standard oncologic operations were done in each case. The first 1-4 blue nodes near the tumor were tagged with suture as SLNs. Data was collected for demographics, tumor pathology and peri-operative events. Results: There were a total of 11 consecutive robotic pts and 15 open pts. The data was compared between the robotic vs open groups as follows: Primary sites including Cecum (1 vs 3), Ascending Colon (3 vs 4), Transverse Colon (4 vs 5), Sigmoid Colon (2 vs 3); Average number of LNs (18.5 vs 17.6); Average number of SLNs (3.3 vs 3.0), and nodal positivity (50% vs 50%). The success rate was 100% in each group. Conclusions: There are great similarities for SLNM between robotic and open surgeries for CCa in regards to success rate, nodal harvest, SLNs, and nodal positivity. Hence, SLNM should be pursued when robotic surgeries are performed for CCa pts as in open cases.
DRS (N = 10) | Open procedure (N = 15) | |
---|---|---|
Sex (female:male) | 4:6 | 11:4 |
Age (yrs) | 64.2 (44-81) | 65.5 (36-80) |
Body mass index | 28.8 (21-40) | 28.2 (18-48) |
Location | ||
Cecum | 1 | 3 |
Ascending | 3 | 4 |
Transverse | 4 | 5 |
Sigmoid | 2 | 3 |
Grade | ||
T0, Tis, TA, TVA | 2 | 1 |
I | 2 | 2 |
II | 4 | 9 |
III | 2 | 3 |
Nodal positivity | ||
Tumor size (cm) | 4.32 (1.5-8) | 4.2 (1-9) |
Avg. total no. of lymph nodes | 18.5 (9-36) | 17.6 (8-36) |
Avg. no. of sentinel lymph lodes | 3.3 (1-5) | 3 (1-7) |
Nodal positivity* | 50% | 50% |
AJCC staging | ||
0 | 2 | 1 |
I | 1 | 3 |
II | 3 | 4 |
III | 2 | 4 |
IV | 2 | 3 |
Peri-opertive events | ||
Operative room time (Min) | 290 (234-397) | 207 (94-286) |
Estimated blood loss (mL) | 165 (100-300) | 190 (100-600) |
Intra-operative complications | 0 | 0 |
Immediate complications | 2 | 3 |
Late complications | 0 | 0 |
2nd operation or intervention for complications | 0 | 1 |
Conversion to open surgery | 0 | N/A |
Length of hospital stay (days) | 8.5 (6-16) | 7.5 (3-14) |
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