Sentinel Lymph Node Biopsy in Rectal Cancer

NCT ID: NCT05830890

Last Updated: 2023-04-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

87 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-05-31

Study Completion Date

2025-12-31

Brief Summary

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Rectal cancer is one of the most common malignant tumors, with 9% to 23% of patients experiencing pelvic sidewall lymph node metastasis. According to the current Chinese guidelines for diagnosing and treating colorectal cancer, pelvic sidewall lymph node dissection is recommended for patients who have experienced or are suspected of having lateral lymph node metastasis. Lateral lymph node dissection can result in longer operation times, increased bleeding, and complications such as urinary and sexual dysfunction after surgery. Currently, the presence of metastasis is primarily determined by the size and enhancement characteristics of lateral lymph nodes observed through imaging studies. However, the pathological lymph node metastasis rate of specimens collected after lateral lymph node dissection based on current imaging criteria is only 20.5%. Therefore, a pressing clinical challenge is accurately determining the presence of lateral lymph node metastasis and avoiding unnecessary lateral lymph node dissection in patients who have not experienced lateral lymph node metastasis.

Sentinel lymph node biopsy has been widely used in clinical practice. It has replaced traditional lymph node dissection in some breast cancer and melanoma patients, reducing surgical risks and complications and improving patients' quality of life. This study aims to use indocyanine green as a tracer for fluorescence-guided laparoscopic navigation to locate the lateral sentinel lymph nodes of rectal cancer in the pelvic cavity. By studying the accuracy, specificity, and false-negative rate of predicting lateral lymph node status using the sentinel lymph node, we can further clarify the clinical significance of the lateral sentinel lymph node.

Detailed Description

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This study is a prospective single-arm clinical study. 87 patients with middle and low rectal cancer are planned to be included in the study. After general anesthesia during the operation, indocyanine green is injected around the tumor through the anus. After the sentinel lymph nodes are developed and located by fluorescent laparoscopy, they are removed and sent to rapid frozen pathological examination, and then the lateral lymph nodes are cleaned. Through pathological examination and statistical analysis of the fluorescent stained lateral sentinel lymph nodes and all the cleaned lateral lymph nodes, To evaluate the clinical significance of lateral sentinel lymph nodes located by this technique in predicting the status of lateral lymph nodes.

Conditions

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Rectal Cancer Stage III Rectal Cancer Stage IV

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Sentinel Lymph Node Biopsy

The fluorescence laparoscope was used to visualize and locate the sentinel lymph node, which was then removed.

Group Type EXPERIMENTAL

Sentinel lymph node biopsy

Intervention Type PROCEDURE

After the total mesorectal excision, the indocyanine green was injected around the tumor via the anus. The fluorescence laparoscope was used to visualize and locate the sentinel lymph node, which was then removed and sent for rapid frozen pathological examination. Subsequently, a lateral lymph node dissection was performed.

Indocyanine green solution

Intervention Type DRUG

Indocyanine green was injected around the tumor via the anus to visualize the sentinel lymph nodes under the fluorescence laparoscope.

fluorescence laparoscope

Intervention Type DEVICE

The fluorescence laparoscope was used to visualize and locate the sentinel lymph node.

pathological examination

Intervention Type DIAGNOSTIC_TEST

The surgical specimens and sentinel lymph nodes were routinely examined for pathology.

rapid frozen pathological examination

Intervention Type DIAGNOSTIC_TEST

The lateral green fluorescence imaging sentinel lymph nodes found during surgery was sent to make cryosections. And then a pathologist makes a rapid diagnosis under a microscope。

total mesorectal excision

Intervention Type PROCEDURE

1. Sharply dissect the vascular interface between the pelvic fascia parietal layer and the visceral layer around the mesentery under direct vision to ensure that the rectal mesentery of the resected specimen is intact and tearless.
2. For medium and low rectal cancer: the distal intestinal tube of the tumor should be resected ≥ 2 cm.
3. TME or mesenteric distal resection margin ≥ 5 cm away from the tumor.

Interventions

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Sentinel lymph node biopsy

After the total mesorectal excision, the indocyanine green was injected around the tumor via the anus. The fluorescence laparoscope was used to visualize and locate the sentinel lymph node, which was then removed and sent for rapid frozen pathological examination. Subsequently, a lateral lymph node dissection was performed.

Intervention Type PROCEDURE

Indocyanine green solution

Indocyanine green was injected around the tumor via the anus to visualize the sentinel lymph nodes under the fluorescence laparoscope.

Intervention Type DRUG

fluorescence laparoscope

The fluorescence laparoscope was used to visualize and locate the sentinel lymph node.

Intervention Type DEVICE

pathological examination

The surgical specimens and sentinel lymph nodes were routinely examined for pathology.

Intervention Type DIAGNOSTIC_TEST

rapid frozen pathological examination

The lateral green fluorescence imaging sentinel lymph nodes found during surgery was sent to make cryosections. And then a pathologist makes a rapid diagnosis under a microscope。

Intervention Type DIAGNOSTIC_TEST

total mesorectal excision

1. Sharply dissect the vascular interface between the pelvic fascia parietal layer and the visceral layer around the mesentery under direct vision to ensure that the rectal mesentery of the resected specimen is intact and tearless.
2. For medium and low rectal cancer: the distal intestinal tube of the tumor should be resected ≥ 2 cm.
3. TME or mesenteric distal resection margin ≥ 5 cm away from the tumor.

Intervention Type PROCEDURE

Other Intervention Names

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Lateral lymph nodes dissection Indocyanine green fluorescence imaging TME

Eligibility Criteria

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Inclusion Criteria

* Aged 18 to 75 years old.
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) score of 0-1.
* Newly diagnosed patients with confirmed rectal cancer by histopathology.
* Preoperative clinical staging by imaging examination is T3-4.
* Preoperative colonoscopy shows the distance from the tumor's lower edge to the anus is less than 10cm.
* No previous chemotherapy or radiotherapy.
* Preoperative imaging examination (pelvic enhanced MRI) shows lateral lymph nodes with a maximum short diameter of ≥5mm and \<10mm.
* Women of childbearing age must take effective contraceptive measures.
* Able to understand the study and sign the informed consent form.

Exclusion Criteria

* Complete intestinal obstruction.
* Active hepatitis and peripheral neuropathy (such as peripheral neuritis, pseudomeningitis, motor neuritis, sensory disturbances, etc.).
* Pregnant or lactating women; women of childbearing potential who have not taken sufficient contraceptive measures.
* History of other tumors or previous chemotherapy or radiotherapy.
* Alcoholism or drug addiction.
* Significant organ dysfunction or other significant diseases, including clinically relevant coronary artery disease, cardiovascular disease, or myocardial infarction within 12 months before enrollment; severe neurological or psychiatric history; severe infection; active disseminated intravascular coagulation.
* Hypoproteinemia.
* Preprandial blood glucose control exceeds 11.2mmol/L in the week before surgery.
* BMI\>28 kg/m\^2.
* Poor compliance, and failure to comply with the study protocol.
* Subject withdrawal from the study
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Center, China

OTHER

Sponsor Role lead

Responsible Party

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Haitao Zhou

Clinical Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Haitao Zhou, M.D.

Role: STUDY_CHAIR

National Cancer Center, China

Locations

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National Cancer Center

Beijing, Beijing Municipality, China

Site Status

Countries

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China

Central Contacts

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Yueyang Zhang, M.D.

Role: CONTACT

+8613552910035

Zheng Xu, M.D.

Role: CONTACT

+8613141127297

Facility Contacts

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Haitao Zhou, M.D.

Role: primary

+8613381167333

Yueyang Zhang, M.D.

Role: backup

+8613552910035

Other Identifiers

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SLNB

Identifier Type: -

Identifier Source: org_study_id

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