LYMPHADENECTOMY IN COLORECTAL-CARCINOMA - A REVIEW

Recurrence of colorectal carcinomas occurs in about 50 % of the cases with localized neoplasia. It is understood that the tumor recurrence i s due to residual micrometastases not found during surgery or extrareg ional (peripheral blood or bone marrow). We developed a procedure to d etect non-visible, abdominal metastases using a radiolabeled anti-tumo r cell antibody injected before the operation (radioimmunoguided surge ry, RIGS). However, even with the best technique, it is not possible t o remove all micrometastasis if a hematogenic dissemination happens. B ased on the knowledge of disturbing humoral immune reaction is mounted against shed tumor associated antigens (TAA), we developed a new meth od to reduce and correct the B cell response and B cell recruitment du e to chronic TAA immun complex presentation on follicular dendritic ce lls (immune corrective surgery, ICS). This method is based on a select ive lymphadenectomy. The target lymph nodes were those loaded with TAA -immune complex. The detection method used was the injection of radiol abeled antibody able to recognize the immune complex. From 20 patients (stage I, II and III) treated with ICS, 17 survived more than 5 years ' showing a statistically significant increase of survival compared t o patients treated with standard procedures. In conclusion, these data show that surgery of colorectal cancer should be selectively extended to specific anatomical regions in order to remove hidden micrometasta ses, and more importantly, correct postoperative immune processes that could suppress the T cell response against residual tumor cells.