Optimal Lymph Node Harvest in Neoadjuvantly Treated Colorectal Cancer Using Methylene Blue Assisted Lymph Node Dissection Technique

Bruno Märkl, Tina Schaller, Ines Krammer, Claudio Cacchi, Hanno Spatz


Lymph node staging is still of crucial importance in rectal cancer. However, the recommendation to evaluate at least 12 lymph nodes for a sufficient staging is often not achieved in daily practice. This problem is even more pronounced after neoadjuvant treatment. The methylene blue assisted lymph node dissection technique (MBLND) has been shown to improve lymph node harvest in gastrointestinal cancers very effectively. A retrospective analysis enrolling 54 cases was performed to investigate the effect of MBLND in neoadjuvantly treated rectal cancer cases. Two historical collections evaluated using conventional dissection technique (n = 47) and fat clearance (FC) technique, respectively served as controls (n = 12). The lymph node harvest was highly significantly improved in the methylene group compared to fat clearance and conventional dissection with mean LN numbers of 29 ± 11, 21 ± 13, and 9 ± 4 (P < 0.001), respectively. Insufficient LN harvest occurred in 72 % of the control group cases, in 17 % of the FC-group and in no case of the Methylene group. Node positivity was found in 24%, 25% and 28% in the MB-, FC- and control group, respectively. MBLND is a highly effective method guaranteeing an optimal lymph node harvest in colorectal cancer even under the difficult conditions of preoperative chemo-radiation. In our hands it was even more effective than a fat clearance technique.


lymph node, colorectal cancer, methylene blue, neoadjuvant

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