THE COMPARATIVE ANALYSIS OF USING VIDEOTHORACOSCOPIC AND OPEN OPERATIONS FOR THE TREATMENT OF PATIENTS WITH TUMORS OF THYMUS

Abstract

Annually over 2,000,000 new cases of non-small-cell lung cancer are diagnosed worldwide. Preoperative N-staging is the most important diagnostic step to determine the prognosis and tactics of further treatment of patients with lung cancer. 20-30% of patients with early stage NSCLC have local or distant recurrence of the disease and 5-year survival in these patients varies from 40 to 85.5%. In this context, there is a need to develop new methods for intraoperative evaluation of regional lymph nodes. One of these methods is the detection and histological examination of a signal lymph node. This approach allows to perform a targeted evaluation of the first lymph node on the path of tumor spread in order to determine the state of the remaining regional lymphatic collectors. However, today there is no “ideal” method for detecting a signal lymph node. It requires developing new approaches to visualizing the pathways of lymph outflow. Objective: compare and evaluate the effectiveness of using methylene blue solutions to visualize lymphatic outflow pathways in laboratory animals (outbred rat). Animals were randomized into 2 groups - 8 in each. The first group was injected subcutaneously in the left thigh with a 1% aqueous solution of methylene blue, the second group - solution of methylene blue with human serum albumin. Depending on the time of exposure, animals were divided randomly into 4 subgroups - 15, 30, 45 and 60 minutes. There was evaluated the effectiveness of marking the pathways of lymph out-flow from the injection site. The effectiveness of marking the pathways of lymph outflow from the injection site was evaluated. As a result of the study, it was demonstrated that the use of a 1% methylene blue solution allows us to adequately visualize the pathways of lymph outflow. The disadvantage of the drug is migration to the next order LN with an exposure lasting 30 minutes. A solution of methylene blue in combination with human serum albumin has a comparable quality of LN visualization. However, it has a slow (> 60 minutes) migration, which is preferred during surgery.

Keywords

signal lymph node / non-small cell lung cancer / micrometastasis / N-staging / sentinel lymph node / methylene blue / human serum albumin

References

[1] 1. Акопов, А.Л. Интраоперационное определение «сигнальных» лимфатических узлов при помощи системы инфракрасной визуали-зации при местно-распространённом немелкоклеточном раке лёгкого / А.Л. Акопов, Г.В. Папаян, И.В. Чистяков // Вестник хирургии им. И.И. Грекова. - 2015. - Т.174. - №4. - С.13-17.

[2] 2. Амиралиев, А.М. Сегментэктомия у больных со злокачественными новообразованиями легких / А.М. Амиралиев, О.В. Пикин, А.Б. Рябов // Онкология. Журнал им. П.А. Герцена. - 2017. - Т.6. - №5. - С.87-95.

[3] 3. Исмагилов, А.Х. Биопсия сигнальных лимфатических узлов: история и современность / А.Х. Исмагилов, Н.Г. Аснина, Г.А. Азаров // Опухоли женской репродуктивной системы. - 2018. - Т.14. - №1. - С.38-46.

[4] 4. Манихас, Г.М. Биопсия сигнального лимфатического узла при меланоме кожи конечностей и туловища / Г.М. Манихас, В.В. Марты-нюк, М.В. Зинькевич // Вестник Санкт-Петербургской государственной медицинской академии им. И.И. Мечникова. - 2008. - №1. - С.107-110.

[5] 5. Bille, A. Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stage I lung cancer patients / A. Bille, K.M. Woo, U.A. European [et al.] // Eur. J. Cardiothorac. Surg. - 2017. - Vol.51, №4. - P.674-679.

[6] 6. Ettinger, D.S. Non-Small Cell Lung Cancer, Version 1.2020, NCCN Clinical Practice Guidelines in Oncology / D.S. Ettinger, D.E. Wood, D.L. Aisner [et al.] // J. Natl. Compr. Canc. Netw. - 2019. - Vol.15, №4. - P.504-535.

[7] 7. Siegel, R.L. Cancer statistics / R.L. Siegel, K.D. Miller, A. Jemal // CA Cancer J. Clinic. - 2019. - Vol.69, №1. - P.7-34.

[8] 8. Silvestri, G.A. Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines / G.A. Silvestri, A.V. Gonzalez, M.A. Jantz [et al.] // Chest. - 2013. - Vol.143, №5. - P.211-250.

[9] 9. Tiffet, O. Sentinel lymph node detection in primary melanoma with preoperative dynamic lymphoscintigraphy and intraoperative γ probe guidance / O. Tiffet, J.L. Perrot, A. Gentil-Perret [et al.] // Br. J. Surg. - 2004. - Vol.91, №7. - P.886-892.

[10] 10. Usman, A.M. Screening for lung cancer: A systematic review and meta-analysis / A.M. Usman, J. Miller, L. Peirson [et al.] // Prev. Med. - 2016. - Vol.89, №3. - P.301-314.

[11] 11. Wishart, G.C. A feasibility study (ICG-10) of indocyanine green (ICG) fluorescence mapping for sentinel lymph node detection in early breast cancer / G.C. Wishart, S.-W. Loh, L. Jones [et al.] // Eur. J. Surg. Oncol. - 2012. - Vol.38, №8. - P.651-656.

[12] 12. Yamashita, S.I. Video-assisted thoracoscopic indocyanine green fluorescence imaging system shows sentinel lymph nodes in non-small-cell lung cancer / S.I. Yamashita, K. Tokuishi, K. Anami [et al.] // J. Thorac. Cardiovasc. Surg. - 2011. - Vol.141, №1. - P.141-144.

RIGHTS & PERMISSIONS

Kovalenko V.V., Dmitrochenko I.V., Zakirov A.R.