Carnoy solution versus GEWF solution for lymph node revealing in colorectal cancer: a randomized controlled trial

Area of Science:

• Oncology
• Surgical Pathology
• Cancer Research

Background:

• Accurate lymph node staging is crucial for colon and rectal cancer treatment.
• Conventional pathological examination may miss some lymph nodes.
• Novel solutions aim to improve lymph node retrieval during surgical resection.

Purpose of the Study:

• To compare the performance of Carnoy solution and GEWF solution in enhancing lymph node retrieval during colon and rectal cancer surgery.
• To evaluate the impact of these solutions on identifying additional metastatic lymph nodes and subsequent patient staging.

Main Methods:

• A randomized clinical trial (NTC02704988) involving patients with colon or rectal cancer undergoing D2 lymphadenectomy.
• Surgical specimens were randomly assigned for conventional examination or additional fixation with Carnoy or GEWF solution.
• Key outcomes included the number of lymph nodes retrieved, additional metastatic lymph nodes identified, lymph node upstaging, and adjuvant therapy indications.

Main Results:

• Both Carnoy and GEWF solutions significantly increased the number of lymph nodes retrieved in both colon and rectal cancer patients compared to the conventional method.
• No significant differences were observed between the solutions and conventional examination regarding the number of additional metastatic lymph nodes identified.
• Lymph node upstaging and complementary indications for adjuvant therapy were not significantly altered by the use of either solution.

Conclusions:

• While Carnoy and GEWF solutions enhance lymph node retrieval, they do not significantly improve patient staging or change treatment decisions in colon and rectal cancer.
• Both lymph node revealing solutions demonstrated comparable performance in all assessed outcomes.
• Further research may explore the clinical significance of increased lymph node yield in specific patient subgroups.