Preventing and treating lymphatic minute metastasis with (32)p-chromic phosphate during an operation

The aim of this work was to study the effectiveness of (32)P-chromic phosphate colloids ((32)P-CP), by stromal injection during cardiac-esophageal carcinoma resection, in the prevention and treatment of minute lymphatic metastasis.

A multipointed infiltrative injection was done on 91 patients with clinically diagnosed cardiac-esophageal carcinoma to the adipose connective tissues of the corresponding bed of the resected lesion or retroperitonial wall, or tissues neighboring the left gastric artery, abdominal aorta, fenestra of aortic arch, pulmonary hilum, and superior mediastinum following the resection of a tumor. For patients with nonresectable lesions, a multipointed superficial injection of (32)P-CP-diluted solution was administered to the tumor and its surrounding invaded tissue, gastric artery, and the mediastinal adipose connective tissue. The dosage of (32)P-CP was 296 ~ 370 MBq/10 mL (8 ~ 10 mCi/10 mL). A simple operative group of 99 cases with clinically diagnosed cardiac-esophageal carcinoma, but without being given an injection of (32) P-CP, served as the control. Survival curves between the 2 groups were obtained using the Kaplan-Meier method and were compared by a log-rank test. The differences in complications following the operation, the positive rate of lymph nodes (LN), the rate of LN metastasis, and the survival rate following the operation between the 2 groups were determined by conducting a monofactorial analysis by a chi(2) test.

No operative deaths occurred in either group. The incidences of perioperative complications were not different statistically between the 2 groups (p > 0.05). The rate of lymph node metastasis, as well as the incidences of mediastinum, supraclavicle, and abdominal lymph node metastasis, showed that there were prominent statistical differences between the 2 groups (p < 0.05). A Kaplan-Meier analysis showed that there was a significant difference between the operative plus irradiation group, compared with the simple operative group (p = 0.0085).

Stromal medication with (32)P-CP during a cardiac-esophageal carcinoma resection is a simple and safe procedure for controlling postoperative lymphatic metastasis and revealed a very fair clinical effectiveness in improving both medium- and long-term survival rates in patients.