Document Detail


Improving diagnostic staging laparoscopy using intraperitoneal lavage of delta-aminolevulinic acid (ALA) for laparoscopic fluorescence diagnosis.
MedLine Citation:
PMID:  10486597     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Lymph node metastases and peritoneal carcinosis, occurring as a result of gastrointestinal cancer, reduce the likelihood that conventional therapy will be adequate to remove the cancer. Although diagnostic techniques have greatly improved, it is not always possible to diagnose the entire extent of the metastases. Often, peritoneal micrometastases are not visible and may be missed during laparoscopic or open surgery. METHODS: Peritoneal carcinosis was induced in WAG-Rij rats (n = 6), by laparoscopically implanting 1,2-dimethylhydrazine-induced colon carcinoma tumor cells (CC531, 5 x 10(5)) at multiple sites within the peritoneal cavity. After 12 days of tumor growth, the animals were given delta-aminolevulinic acid (ALA) (5 mL, 3% solution in 0.17 mol/L NaHCO3) by peritoneal lavage. The tumors were visualized laparoscopically using both white and blue light (D-light, Karl Storz, Tuttlingen, Germany). Fluorescence was detected by using a modified CCD camera and a special observation filter incorporated into the laparoscope. RESULTS: Peritoneal carcinoma foci ranging in size from 0.05 to 2.0 cm were clearly visible laparoscopically with conventional white light (n = 142). After blue light excitation, all 142 tumors identified with white light were also identified by fluorescence. There were an additional 30 tumors that could only be identified by blue light-induced fluorescence and were histologically confirmed to be derived from colon carcinoma tumor cells. CONCLUSIONS: Peritoneal colonic carcinoma foci were detected laparoscopically after intraperitoneal lavage with delta-aminolevulinic acid (ALA) and excitation with blue light. These experiments demonstrate that fluorescence laparoscopy is an important technique for the staging of gastrointestinal cancer, including colorectal cancer, because of the enhanced ability to detect small cancerous foci.
Authors:
J Gahlen; J Stern; H H Laubach; M Pietschmann; C Herfarth
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery     Volume:  126     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-09-28     Completed Date:  1999-09-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  469-73     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Heidelberg, Germany.
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MeSH Terms
Descriptor/Qualifier:
Aminolevulinic Acid / diagnostic use*
Animals
Colonic Neoplasms / diagnosis,  pathology
Fluorescence
Gastrointestinal Neoplasms / diagnosis,  pathology
Humans
Irrigation
Laparoscopy / methods*
Male
Neoplasm Staging / methods*
Peritoneal Cavity
Peritoneal Neoplasms / diagnosis*,  pathology,  secondary*
Photosensitizing Agents / diagnostic use*
Rats
Chemical
Reg. No./Substance:
0/Photosensitizing Agents; 106-60-5/Aminolevulinic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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