Burçin ÇELİK, Oğuz AYDIN, Ahmet BAŞOĞLU, Ali Osman AKDAĞ

Özefagus kanserinde endoskopik lugol boyama yöntemi ile proksimal cerrahi rezeksiyon sınırının tespiti

Amaç: Özefagus kanserli hastalarda, normal özefegus mukozasının Lugol solüsyonu ile boyanma özelliğinden yararlanarak cerrahi tedavide güvenli rezeksiyon sınırını belirlemedeki değerini araştırmaktır. Materyal ve Metod: Ocak 2001-Mayıs 2003 arasında özefegus kanseri nedeniyle rezeksiyon uygulanan 17 hasta çalışmaya dahil edildi. Hastalarda, preoperatif endoskopik Lugol boyama uygulanarak tümörün proksimal yayılım sınırları belirlendi. Rezeksiyon sonrası özefagus spesmeninde Lugol boyama tekrarlandı. Boyalı spesmenlerin fotoğrafı çekildi ve spesmenler histopatolojik olarak incelenerek patoloji haritaları çıkarıldı. Elde edilen histopatoloji haritaları ile Lugol boyalı spesmenlerin fotografları karşılaştırıldı. Bulgular: Olguların dokuzu erkek, sekizi kadın idi. Yaş ortalaması 59 ± 11.4 yıl ortalama değer (45-76) bulundu. Histopatolojik değerlendirmede 15 olguda epidermoid karsinom, iki olguda adenokarsinom tespit edildi. Tümör, hastaların yedisinde (%41) özefagus 1/3 alt segmentinde lokalize idi. Olguların %59’unun Evre III olduğu tespit edildi. Lugol boyama ile 12 olguda (%70) tümörün makroskopik yayılımdan daha geniş olduğu gözlendi. Sonuç: Özefagus kanserinin ve mukozal yayılımın belirlenmesinde güvenli bir rezeksiyon sınırı elde edebilmek için Lugol boyama kolay, pratik ve güvenli bir yöntem olarak uygulanabilir.

Determination of the proximal resection line in esophageal carcinoma using endoscopic examination with lugol staining

Background: The purpose of this study is to research the value of determination of the safe resection line in the surgical treatment by using the property that healthy esophageal mucosa can be stained with Lugol solution in the patients with esophageal carcinoma.Methods: Seventeen cases who underwent resection because of esophageal carcinoma were studied between January 2001 and May 2003. In these patients the proximal spread lines of the tumor were determined by using endoscopic Lugol staining preoperatively. After resection, the Lugol staining was repeated in the esophagus specimen. The photos of the stained specimens were taken. Then the maps of the specimens were determined by histopathologically. The photos of the histopathologic maps and the specimens stained with lugol were compared.Results: Nine of the cases were female and eight were male with mean age 59 ± 11.4 years (range 45 to 76). In 15 cases epidermoid carcinoma, in two cases adeno carcinoma were determined in histopathologic evaluation. Tumors were localized in seven patients at 1/3 lower segment of the esophagus. Fifty-nine percent of the patients were in stage III. It was observed that macroscopic spread with lugol staning was larger in 12 (70%) cases.Conclusions: It has been confirmed that the Lugol staining can be put in to practice as a simple, practical and safe method to obtain a safe resection line in the determination of the esophageal carcinoma and the mucosal spread.

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