Fluorescence-based sentinel lymph node mapping and lymphography evaluation: results from the IHU-IRCAD-EAES EURO-FIGS registry.

Autor: Picchetto A; Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. andrea.picchetto@gmail.com., Cinelli L; Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France.; IRCCS San Raffaele Scientific Institute, Milan, Italy., Bannone E; Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France.; Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy.; Department of Pancreatic Surgery, Verona University, Verona, Italy., Baiocchi GL; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy., Morales-Conde S; Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain.; General and Digestive Unit, Hospital Quironsalud Sagrado Corazon, Seville, Spain., Casali L; Ospedale di Vaio, Fidenza, Italy., Spinoglio G; Candiolo Cancer Institute IRCCS, Candiolo, Italy., Franzini C; Ospedale di Vaio, Fidenza, Italy., Santi C; Ospedale di Vaio, Fidenza, Italy., D'Ambrosio G; Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy., Copaescu C; Ponderas Academic Hospital, Bucharest, Romania., Rollo A; Ospedale di Vaio, Fidenza, Italy., Balla A; UOC of General and Minimally Invasive Surgery, Hospital 'San Paolo', Largo Donatori del Sangue 1, 00053, Rome, Civitavecchia, Italy., Lepiane P; UOC of General and Minimally Invasive Surgery, Hospital 'San Paolo', Largo Donatori del Sangue 1, 00053, Rome, Civitavecchia, Italy., Paganini AM; Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy., Detullio P; Ospedale di Vaio, Fidenza, Italy., Quaresima S; Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy., Pesce A; GF Ingrassia, Catania, Italy., Luciano T; Ospedale di Vaio, Fidenza, Italy., Bianchi G; Ospedale di Vaio, Fidenza, Italy., Marescaux J; Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France., Diana M; Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France.; University of Strasbourg, Strasbourg, France.; Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.; ICube Laboratory, Photonics for Health, University of Strasbourg, Strasbourg, France.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 Jul; Vol. 37 (7), pp. 5472-5481. Date of Electronic Publication: 2023 Apr 12.
DOI: 10.1007/s00464-023-10043-8
Abstrakt: Background: The identification of metastatic lymph nodes is one of the most important prognostic factors in gastrointestinal (GI) cancers. Near-infrared fluorescence (NIRF) imaging has been successfully used in GI tumors to detect the lymphatic pathway and the sentinel lymph node (SLN), facilitating fluorescence image-guided surgery (FIGS) with the purpose to achieve a correct nodal staging. The aim of this study was to analyze the current results of NIRF SLN navigation and lymphography through data collected in the EURO-FIGS registry.
Methods: Prospectively collected data regarding patients and ICG-guided lymphadenectomies were analyzed. Additional analyses were performed to identify predictors of metastatic SLN and determinants of fluorescence positivity and nodal metastases outside the boundaries of standard lymphadenectomies.
Results: Overall, 188 patients were included by 18 surgeons from 10 different centers. Colorectal cancer was the most reported pathology (77.7%), followed by gastric (19.1%) and esophageal tumors (3.2%). ICG was injected with higher doses (p < 0.001) via extraparietal side (63.3%), and with higher volumes (p < 0.001) via endoluminal side (36.7%). Overall, NIRF SLN navigation was positive in 75.5% of all cases and 95.5% of positive SLNs were retrieved, with a metastatic rate of 14.7%. NIRF identification of lymph nodes outside standard lymphatic stations occurred in 52.1% of all cases, 43.8% of which were positive for metastatic involvement. Positive NIRF SLN identification was an independent predictor of metastasis outside standard lymphatic stations (OR = 4.392, p = 0.029), while BMI independently predicted metastasis in retrieved SLNs (OR = 1.187, p = 0.013). Lower doses of ICG were protective against NIRF identification outside standard of care lymphadenectomy (OR = 0.596, p = 0.006), while higher volumes of ICG were predictive of metastatic involvement outside standard of care lymphadenectomy (OR = 1.597, p = 0.001).
Conclusions: SLN mapping helps identifying potentially metastatic lymph nodes outside the boundaries of standard lymphadenectomies. The EURO-FIGS registry is a valuable tool to share and analyze European surgeons' practices.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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