A pilot study of lymph node mapping with indocyanine green in robotic gastrectomy for gastric cancer

Abstract

Objectives:Robotic gastrectomy has become increasingly popular in the treatment of gastric cancer, especially in Asian countries. The use of indocyanine green fluorescence has been reported in lymphatic mapping for gastric cancer in laparoscopic gastrectomy; however, there have been few reports regarding the use of indocyanine green in robotic gastrectomy.Methods:From January 2011 to March 2016, a total of 79 patients underwent robotic gastrectomy for gastric cancer. Among them, intraoperative subserosal injection (n = 9) or preoperative submucosal injection (n = 5) of indocyanine green with near-infrared imaging was performed in 14 patients, and the other 65 patients underwent robotic gastrectomy without the use of indocyanine green.Results:There was no significant difference in the operative time, total number of retrieved lymph nodes, operative blood loss, and postoperative hospital stay between the patients who underwent robotic gastrectomy with or without indocyanine green fluorescence. For each lymph node station, there was significantly more number of retrieved lymph nodes in the indocyanine green group than in the no-indocyanine green group at the greater curvature side of the low body (#4d) to the infrapyloric region (#6) of the stomach. Five of the 14 patients who received an indocyanine green injection for lymphatic mapping had lymph node metastasis, and metastatic lymph nodes were located in the lymph node stations as detected by indocyanine green fluorescence during surgery.Conclusion:Indocyanine green fluorescence with near-infrared imaging is feasible and is a promising method of lymphatic mapping in robotic gastrectomy for gastric cancer. In future studies, larger patient numbers and long-term follow-up are required.

The Short-term and Long-term Outcomes of Indocyanine Green Tracer-Guided Laparoscopic Radical Gastrectomy in Patients with Gastric Cancer

“…Our study found that ICG is not associated with increased incidence of perioperative complications, which is consistent with previous literature [15][16][17]25 . We also found that the postoperative hospital stay was similar between two groups, which prompted similar recovery process.…”

“…Traditionally, ICG administration includes subserosal and submucosal injections around the tumor [14][15][16][17]25 . Previous studies suggested that submucosal injection is superior than subserosal injection in intraoperative lymph node detection 14 .…”

“…Previous studies suggested that submucosal injection is superior than subserosal injection in intraoperative lymph node detection 14 . And subserosal injection often caused ICG leakage and surgical eld blur 17 . Therefore, we adopted submucosal injection of ICG in our study, Previous studies suggested preoperative injection of ICG 15,16 , since they assumed that it takes time for ICG to spread into lymph nodes and prolongs the operation time.…”

“…It was initially used in sentinel lymph node navigation and anastomotic blood ow visualization 10,12,13 . Recent studies begin to investigate the safety and effectiveness of ICG navigation in lymphadenectomy during laparoscopic radical gastrectomy [14][15][16][17] . However, there lack studies that report the long-term outcome in patients receiving ICG-guided gastrectomy.…”

Fluorescent‐guided surgery for sentinel lymph node detection in gastric cancer and carcinoembryonic antigen targeted fluorescent‐guided surgery in colorectal and pancreatic cancer

“…However, more false‐positive lymph nodes were found than anticipated due to spread of the contrast agent through lymphatic vessels to second‐tier lymph nodes . Hence, no additional value of the NIRF was observed, since still too many lymph nodes were unnecessarily resected …”