| Objective: To investigate the value of preoperative endoscopic carbon nanotracer in laparoscopic radical resection of colorectal cancer.Methods: This study retrospectively analyzed 108 patients treated in the first affiliated Hospital of Hainan Medical College from August 2020 to December 2022.All patients were diagnosed with colorectal cancer by enteroscopy and pathology.The patients were randomly divided into carbon nanoparticles group and control group according to the method of random number table,and then the patient clinical data archives(age,sex,BMI,tumor location,ASA grade,TNM,etc.)were established and improved.Then the patients who did not meet the standard were excluded according to the clinical data.In order to form comparable baseline characteristics between the two groups,the two groups were divided into nano-carbon group(n = 30)and control group(n = 30)according to the 1:1 tendency score.Patients in the nano-carbon group received endoscopic carbon injection one day before operation,followed by laparoscopic radical resection of colorectal cancer,while patients in the control group received laparoscopic radical resection of colorectal cancer.Statistical methods such as independent sample t-test and chi-square test were used to compare the general data of the two groups(sex,age,body mass index,tumor location,ASA grade,TNM stage),operation(operation time,blood loss,postoperative anal exhaust time,hospital stay),lymph node detection(total lymph node detection,number of micro lymph nodes,black-stained lymph nodes,positive lymph nodes,sentinel lymph nodes,Lymph node detection time),postoperative TNM stage,postoperative complications and follow-up after discharge.Results:1.Comparison of general materials: There were no significant differences in sex,age,BMI,tumor site,ASA grade and TNM stage between the two groups(P > 0.05).2.Comparison of operation condition:There was no significant difference in hospitalization time and anal first exhaust time between nano-carbon group and control group(P > 0.05),the time of operation and the amount of bleeding in the nano-carbon group were less than those in the control group(p < 0.05).3.Contrast of lymph node detection: 850 lymph nodes were detected in two groups.A total of 478 lymph nodes were detected in the nanocarbon group and 372 lymph nodes were detected in the control group,the average number of lymph nodes detected in the nanocarbon group and the control group [15.93 ± 2.42(10-21)vs 12.3 ± 1.97(9-16)],there were 129 metastatic lymph nodes in the nanocarbon group(43 of them were microlymph nodes < 5mm),and there were significant differences between the two groups(p < 0.05),there were 60 metastatic lymph nodes in the control group(14 of them were small lymph nodes < 5mm),and the positive rate of lymph nodes in the nanocarbon group was 26.9%(129/478)vs 16.1%(60/372),with a significant difference between the two groups(p < 0.05).A total of 154 microlymph nodes were detected in the nanocarbon group,and 49 microlymph nodes were detected in the control group.The mean number of microlymph nodes detected in the nanocarbon group and the control group [5.0(4.0,6.2)vs 2.0(1.0,2.0)],the detection rate of microlymph nodes in the nanocarbon group was 32.2%(154/478)vs 13.1%(49/372)in the control group(p < 0.05).The positive rate of microlymph nodes in the nanocarbon group and the control group [27.9%(43/154)vs 28.5%(14/49)] was not statistically significant(p > 0.05).Compared with the control group,the detection time of pathologists in the nano-carbon group was shorter,the difference was statistically significant(p < 0.05).6.6%(2/30)of the patients with less than 12 lymph nodes in the nanocarbon group were significantly lower than 30%(9/30)of the control group(p <0.05).4.Lymph node staining: A total of 478 lymph nodes and 256 black-stained lymph nodes(83 pieces of positive lymph nodes positive +173 pieces of positive lymph nodes negative)were detected in the nanocarbon group,there were 222 non-blackened lymph nodes(46 pieces of positive lymph nodes positive + 176 pieces of positive lymph nodes negative).The positive rate of black-stained lymph nodes was 53.5%(256/478),and the positive rate of black-stained lymph nodes was 32.4%(83/256),which was significantly higher than that of non-black-stained lymph nodes(20.7%(46/222)(P < 0.05).5.The Sentinel lymph node:In the nanocarbon group,58 Sentinel lymph nodes were detected,with an average of 2.1 ± 0.75 Sentinel lymph nodes,the positive rate of lymph node was 37.9%(22/58),and the metastatic rate of Sentinel lymph node was25.4%(107/420).The positive rate of tumor cells in Sentinel lymph node was higher than that in Sentinel lymph node,there was significant difference between the two groups(p < 0.05).The accuracy of the Sentinel lymph node was 93.3%,the sensitivity was 92.6%,the specificity was 100%,the positive accuracy was 100%,and the negative accuracy was 60.0%.6.Postoperative TNM staging:The postoperative TNM staging of 11 patients in the nanometer carbon group was higher than that of the preoperative staging,while the postoperative TNM staging of 3 patients in the control group was higher than that of the preoperative staging,and the rising rate of the nanometer carbon group was 36.7%(11/30).The rate of increase in the control group was 10.0%(3/30).There was statistical significance in the analysis and comparison of the data between the two groups(P < 0.05).7.Comparison of postoperative complications and follow-up: 1 case of infection,2cases of anastomotic leakage,2 cases of urinary tract complications in nano-carbon group;In the control group,infection occurred in 1 case,hemorrhage in 2 cases and anastomotic sputum in 1 case.There was no significant difference in postoperative complications between the two groups(P > 0.05).The survival analysis showed that the prognosis of nano-carbon group was better than that of the control group,but there was no significant difference between the two groups(P > 0.05).Conclusion:1.Preoperative endoscopic carbon nanotag is helpful to confirm the extent of the lesion and lymph node dissection,to shorten the operation time and reduce the amount of bleeding,and to help pathologists to sort out the lymph nodes more quickly.2.The detection of total lymph nodes in colorectal cancer laparoscopy by preoperative endoscopic carbon labeling was significantly increased,especially for the detection of small lymph nodes,and the detection of positive lymph nodes was also increased It can also be used in Sentinel lymph node biopsy to predict regional lymph node metastasis,and it may be helpful for more accurate pathological staging and guiding adjuvant therapy after surgery.3.It is a safe and reliable method to use nano-carbon labeling before operation without increasing the first postoperative anal exsufflation,length of hospital stay and complications. |
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