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Application of Near-Infrared Fluorescence Imaging with Indocyanine Green in Totally Laparoscopic Distal Gastrectomy

Journal of Gastric Cancer 2020년 20권 3호 p.290 ~ 299
Liu Maoxing, Xing Jiadi, Xu Kai, Yuan Peng, Cui Ming, Zhang Chenghai, Yang Hong, Yao Zhendan, Zhang Nan, Tan Fei, Su Xiangqian,
소속 상세정보
 ( Liu Maoxing ) - Peking University Cancer Hospital and Institute Department of Gastrointestinal Surgery
 ( Xing Jiadi ) - Peking University Cancer Hospital and Institute Department of Gastrointestinal Surgery
 ( Xu Kai ) - Peking University Cancer Hospital and Institute Department of Gastrointestinal Surgery
 ( Yuan Peng ) - Peking University Cancer Hospital and Institute Department of Endoscopy
 ( Cui Ming ) - Peking University Cancer Hospital and Institute Department of Gastrointestinal Surgery
 ( Zhang Chenghai ) - Peking University Cancer Hospital and Institute Department of Gastrointestinal Surgery
 ( Yang Hong ) - Peking University Cancer Hospital and Institute Department of Gastrointestinal Surgery
 ( Yao Zhendan ) - Peking University Cancer Hospital and Institute Department of Gastrointestinal Surgery
 ( Zhang Nan ) - Peking University Cancer Hospital and Institute Department of Gastrointestinal Surgery
 ( Tan Fei ) - Peking University Cancer Hospital and Institute Department of Gastrointestinal Surgery
 ( Su Xiangqian ) - Peking University Cancer Hospital and Institute Department of Gastrointestinal Surgery

Abstract


Purpose: Recently, totally laparoscopic gastrectomy has been gradually accepted by surgeons worldwide for gastric cancer treatment. Complete dissection of the lymph nodes and the establishment of the surgical margin are the most important considerations for curative gastric cancer surgery. Previous studies have demonstrated that indocyanine green (ICG)-traced laparoscopic gastrectomy significantly improves the completeness of lymph node dissection. However, it remains difficult to identify the tumor location intraoperatively for gastric cancers that are staged ≤T3. Here, we investigated the feasibility of ICG fluorescence for lymph node mapping and tumor localization during totally laparoscopic distal gastrectomy.

Materials and Methods: Preoperative and perioperative data from consecutive patients with gastric cancer who underwent a totally laparoscopic distal gastrectomy were collected and analyzed. The patients were categorized into the ICG (n=61) or the non-ICG (n=75) group based on whether preoperative endoscopic mucosal ICG injection was performed.

Results: The ICG group had a shorter operation time and less intraoperative blood loss. Moreover, significantly more lymph nodes were harvested in the ICG group than the non-ICG group. No pathologically positive margin was found and there was no significant difference in either the proximal or distal surgical margins between the 2 groups.

Conclusions: Near-infrared fluorescence imaging with ICG can be successfully used in totally laparoscopic distal gastrectomy, and it contributes to both the completeness of D2 lymph node dissection and confirmation of the gastric transection line. Well-designed prospective randomized studies are needed in the future to fully validate our findings.

키워드

Gastric cancer; Gastrectomy; Indocyanine green; Tumor; Lymph node dissection

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