Die lymphatische Darstellung im Kolonkarzinom ist abhängig von Tracer und Injektionszeitpunkt: Ein systematisches Review und Meta-Analyse prospektiv konzipierter Studien

Abstract

This systematic review with meta-analysis was conducted according to PRISMA guidelines. Traced lymph nodes, total resected lymph nodes, and aberrant drainage detection rates were analyzed. 58 studies met the inclusion criteria, of which 42 searched for aberrant drainage. While a preoperative tracer injection significantly increased the traced lymph node rates compared to intraoperative tracer application (30.1% (15.4, 47.3) vs. 14.1% (11.9, 16.5), p = 0.03), no effect was shown for the tracer used (p = 0.740) or the application sites comparing submucosal and subserosal injection (22.9% (14.1, 33.1) vs. 14.3% (12.1, 16.8), p = 0.07). Preoperative tracer injection resulted in a significantly higher rate of detected aberrant lymph nodes compared to intraoperative injection (26.3% [95% CI 11.5, 44.0] vs. 2.5% [95% CI 0.8, 4.7], p<0.001). Analyzing 112 individual patient data sets from seven studies revealed a significant impact on aberrant drainage detection for injection timing, favoring preoperative over intraoperative injection (OR 0.050 [95%CI 0.010-0.176], p <0.001) while ICG presented itself as the superior tracer (OR 0.127 [95%CI 0.018-0.528], p= 0.012). Optimized lymphatic mapping techniques result in significantly higher detection of aberrant lymphatic drainage patterns and thus enable a personalized approach, possibly reducing local recurrence in future.