Clinical Study On Improving The Accuracy Of Lymph Node Staging After Neoadjuvant Treatment Of Local Advanced Esophageal Gastric Junction Adenocarcinoma With Nano Carbon Suspension

Objective:To explore the clinical value of the application of nano-carbon suspension(CNSI)to improve the accuracy of lymph node staging after neoadjuvant treatment of locally advanced adenocarcinoma of the esophagogastric junction.Methods:A total of 56 patients with gastroesophageal junction adenocarcinoma who were clinically staged locally in the third department of the Fourth Hospital of Hebei Medical University from November 2017 to November 2019 were selected.They were randomly divided into an experimental group and a control group,with 28 persons in each group.In the experimental group,CNSI was injected within 24 hours before neoadjuvant treatment,and CNSI was injected within 24 hours before surgery.All patients received chemotherapy(oxaliplatin + capecitabine chemotherapy regimen 2 cycles)+ radiotherapy(45Gy / 25 f,5 times / week)+ supplementary therapy(apatinib mesylate orally 0.25 g / Day 56 days)in neoadjuvant treatment,the patients will record the number of lymph nodes,the number of stained lymph nodes and the number of microlymph nodes after 8-10 weeks after the end of radiation therapy.Lymph node pathological staging and complication rate.Results:1.There were no differences in basic information and surgical related data(age,gender,BMI,c TNM staging,histological type,degree of differentiation,and regression grade)between the two groups of patients(P> 0.05).2.There was no significant difference in the incidence of postoperative anastomotic fistula,pulmonary infection,postoperative wound infection,postoperative bleeding and other complications between the experimental group and the control group(P> 0.05).3.Comparison of two groups of dissected lymph nodesTotal number of lymph nodes detected: 1072 lymph nodes were collected in the experimental group and 831 in the control group.The average number of detected lymph nodes: the experimental group(38.29±8.19)and the control group(29.68±7.57),the difference was statistically significant(P <0.05).The number of microlymph nodes detected:291 lymph nodes were collected in the experimental group and 220 in the control group.The average of(10.39±4.81)cases in the experimental group and(7.86±2.32)cases in the control group,the difference was statistically significant(P <0.05).Lymph node metastasis rate: The lymph node metastasis rate in the experimental group was 4.76%(51/1072),which was 4.33%(36/831)compared with the control group,and the difference was not statistically significant(P> 0.05).Black-stained lymph node metastasis rate: 6.42%(42/654)in the experimental group and 5.38%(22/409)in the control group,with no significant difference(P> 0.05).The non-stained lymph node metastasis rate in the experimental group was 2.15%(9/418),which was significantly lower than the black-stained lymph node metastasis rate in the experimental group 6.42%(42/654),and the difference was statistically significant(P <0.05).The unstained lymph node metastasis rate of the control group was 3.32%(14/422),which was also lower than the control group's black stained lymph node metastasis rate of 5.38%(22/409).The difference between the two was statistically significant(P <0.05).4.Lymph node staging comparison: pN0 in the experimental group was 16 cases,pN1 was 4 cases,pN2 was 3 cases,pN3 was 5 cases,control group pN0 was 19 cases,pN1 was 5 cases,pN2 was 3 case,and pN3 was 1 cases.There was a statistically significant difference in pN(P <0.05).Conclusions:1.The application of nano carbon suspension before neoadjuvant treatment can increase the number of lymph nodes detected after operation,especially the number of positive lymph nodes and micro lymph nodes.2.The application of nano carbon suspension before neoadjuvant treatment can reduce the influence of neoadjuvant treatment on lymph node acquisition,reduce the stage bias caused by neoadjuvant treatment,and is conducive to accurate lymph node stage.