2000 Volume 33 Issue 6 Pages 716-720
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 la-paroscopic 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.
