Fluorescence-guided lymphadenectomy in gastric cancer: a prospective western series

Autor: Luca Arru, Stefania Manenti, Federico Gheza, Sarah Molfino, Beatrice Molteni, Gian Luca Baiocchi, Luca Quarti, Giuseppina Arcangeli, Maristella Botticini
Rok vydání: 2020
Předmět:
Adult
Indocyanine Green
Male
medicine.medical_specialty
genetic structures
medicine.medical_treatment
FLUORESCENCE-GUIDED SURGERY
GASTRIC CANCER
INDOCYANINE GREEN
LYMPHADENECTOMY
NAVIGATION SURGERY
Fluorescence-guided surgery
Gastric cancer
Indocyanine green
Lymphadenectomy
Navigation surgery
Fluorescence
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Patient age
Stomach Neoplasms
Tumor stage
medicine
Fluorescent tracer
Humans
Prospective Studies
Lymph node
Aged
Aged
80 and over
business.industry
Cancer
Middle Aged
medicine.disease
eye diseases
Surgery
medicine.anatomical_structure
chemistry
Surgery
Computer-Assisted
030220 oncology & carcinogenesis
Lymphatic Metastasis
Feasibility Studies
Lymph Node Excision
030211 gastroenterology & hepatology
Female
Radiology
business
Cancer surgery
Zdroj: Updates in surgery. 72(3)
ISSN: 2038-3312
Popis: Indocyanine green (ICG) has been recently introduced in clinical practice as a fluorescent tracer. Lymphadenectomy is particularly challenging in gastric cancer surgery, owing to the complex anatomical drainage.The primary outcomes of this study were the feasibility and usefulness of ICG-guided lymphadenectomy in gastric cancer surgery, considering both the success rate and improved understanding of the surgical anatomy of nodal basins. The secondary outcome was the diagnostic ability of ICG to predict the presence of nodal metastases.We conducted a single-center prospective trial comprising 13 patients with gastric cancer. ICG was injected the afternoon prior to surgery or intraoperatively via the submucosal or subserosal route. Standard lymphadenectomy was performed in all patients, according to patient age and tumor stage, as usual, but after standard lymphadenectomy the residual ICG + nodes were harvested and analyzed. Each nodal station and each dissected node was recorded and classified as ICG + or ICG- (both in vivo and back table evaluation was utilized for classification). After pathological analysis, each nodal station and each dissected node was recorded as metastatic or nonmetastatic (EE staining).The feasibility rate was 84.6% (11/13). The mean number of dissected lymph nodes per patient was 37.9. Focusing on the 11 patients in whom ICG-guided nodal navigation was successfully performed, 81 lymph node stations were removed, for a total of 417 lymph nodes. Sixty-six stations (81.48%), comprising a total of 336 lymph nodes, exhibited fluorescence. No IC- node was metastatic; all 54 metastatic nodes were ICG + . A total of 282 ICG + nodes were nonmetastatic. In two cases, some nodes outside D2 areas were harvested, being ICG + (1 case of metastatic node).Fluorescence lymphography-guided lymphadenectomy is a promising new technique that combines a high feasibility rate with considerable ease of use. Regarding its diagnostic value, the key finding from this prospective series is that no metastatic nodes were found outside fluorescent lymph node stations. Further studies are needed to investigate whether this technique can help surgeons performing standard lymphadenectomy and selecting cases for D2 + lymphadenectomy.
Databáze: OpenAIRE
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