Assessment of indocyanine green fluorescence lymphography on lymphadenectomy during minimally invasive gastric cancer surgery: a systematic review and meta-analysis

Pang, Hua-Yang; Liang, Xiaofeng; Chen, Xiao-Long; Zhou, Quan; Zhao, Lin-Yong; Li, Kai; Zhang, Weihan; Yang, Kun; Liu, Kai

doi:10.1007/s00464-021-08830-2

Cited by 15 publications

(11 citation statements)

References 37 publications

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“…However, ICG fluorescence imaging in radical gastrectomy remains a controversial issue, due to the lack of high-quality evidence. Two recent meta-analyses showed that ICG fluorescence imaging led to a higher number of harvested lymph nodes, lower intraoperative blood loss, and shorter hospitalization length, if compared to conventional surgery [28,29]. As a matter of fact, following ICG administration, a clearer identification of the lymphatic structures takes place and fluorescent lymph nodes seem more easily recoverable, leaving the neighboring structures (large vessels, in particular) unaltered, although Yang et al did not find any advantage in terms of overall and specific postoperative complications in the ICG group [28,29].…”

Section: Discussionmentioning

confidence: 99%

“…Two recent meta-analyses showed that ICG fluorescence imaging led to a higher number of harvested lymph nodes, lower intraoperative blood loss, and shorter hospitalization length, if compared to conventional surgery [28,29]. As a matter of fact, following ICG administration, a clearer identification of the lymphatic structures takes place and fluorescent lymph nodes seem more easily recoverable, leaving the neighboring structures (large vessels, in particular) unaltered, although Yang et al did not find any advantage in terms of overall and specific postoperative complications in the ICG group [28,29]. Our paper records an advantage of RG over LG, as far as number of recovered lymph nodes and estimated intraoperative blood loss are concerned [14][15][16][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

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Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review

et al. 2022

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Background and Objectives: Gastrectomy with D2 lymphadenectomy is the standard surgical treatment with curative intent for patients with gastric cancer (GC). Over the last three decades, surgeons have been increasingly adopting laparoscopic surgery for GC, due to its better short-term outcomes. In particular, laparoscopic gastrectomy (LG) has been routinely used for early gastric cancer (EGC) treatment. However, LG suffers from technical limitations and drawbacks, such as a two-dimensional surgical field of view, limited movement of laparoscopic tools, unavoidable physiological tremors and discomfort for operating surgeon. Therefore, robotic surgery has been developed to address such limitations. Materials and Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines in order to investigate the benefits and harms of robotic gastrectomy (RG) compared to the LG. PubMed/MEDLINE, Scopus, Cochrane Library (Cochrane Database of Systematic Re-views, Cochrane Central Register of Controlled Trials-CENTRAL) and Web of Science (Science and Social Science Citation Index) databases were used to search all related literature. Results: The 7 included meta-analyses covered an approximately 20 years-study period (2000–2020). Almost all studies included in the meta-analyses were retrospective ones and originated from Asian countries (China and Korea, in particular). Examined overall population ranged from 3176 to 17,712 patients. If compared to LG, RG showed both operative advantages (operative time, estimated blood loss, number of retrieved lymph nodes) and perioperative ones (time to first flatus, time to restart oral intake, length of hospitalization, overall complications, Clavien-Dindo (CD) ≥ III complications, pancreatic complications), in the absence of clear differences of oncological outcomes. However, costs of robotic approach appear significant. Conclusions: It is impossible to make strong recommendations, due to the statistical weakness of the included studies. Further randomized, possibly multicenter trials are strongly recommended, if we want to have our results confirmed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review

et al. 2022

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“…12 A recent meta-analysis of 1884 patients with gastric cancer demonstrated the feasibility and safety of ICGguided LN dissection. 10 A prospective nonrandomized study also found that ICG could improve LN dissection quality in radical robotic gastrectomy. 13 Another RCT (FUGES-019) conducted by our center found that intraoperative subserosal injection of ICG improved patient satisfaction and reduced the economic burden without affecting LN visualization compared with preoperative submucosal injection.…”

mentioning

confidence: 96%

“…Intraoperative near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) is a novel technique that has shown satisfactory results in LN mapping in several malignant tumors. [8][9][10] ICG fluorescence enables better tissue penetration, resulting in more accurate identification of LNs in hypertrophic adipose tissues. 11 Given the complex lymphatic drainage of the stomach, ICG-guided real-time LN navigation has great potential for D2 lymphadenectomies.…”

mentioning

confidence: 99%

“…Our center conducted a phase 3 randomized controlled trial (RCT; Fujian Medical University Union Hospital Gastric Surgery Study Group [FUGES]-012) and reported that ICG could increase the number of retrieved LNs and reduce LN noncompliance during laparoscopic gastrectomy 12 . A recent meta-analysis of 1884 patients with gastric cancer demonstrated the feasibility and safety of ICG-guided LN dissection 10 . A prospective nonrandomized study also found that ICG could improve LN dissection quality in radical robotic gastrectomy 13 .…”

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confidence: 99%

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Assessment of Laparoscopic Indocyanine Green Tracer-Guided Lymphadenectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

Huang,

Tang,

Zhong

et al. 2024

Annals of Surgery

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Objective: To assess the effectiveness of indocyanine green (ICG)-guided lymph node (LN) dissection during laparoscopic radical gastrectomy after neoadjuvant chemotherapy (NAC) in patients with LAGC. Summary Background Data: Studies on ICG imaging use in patients with LAGC on NAC are rare. Methods: Patients with gastric adenocarcinoma (clinical T2-4NanyM0) who received NAC were randomly assigned to receive ICG-guided laparoscopic radical gastrectomy or laparoscopic radical gastrectomy alone. Here, we reported the secondary endpoints including the quality of lymphadenectomy (total retrieved LNs and LN noncompliance) and surgical outcomes. Results: Overall, 240 patients were randomized. Of whom, 236 patients were included in the primary analysis (118 in the ICG group and 118 in the non-ICG group). In the ICG group, the mean number of LNs retrieved was significantly higher than in the non-ICG group within the D2 dissection (48.2 vs. 38.3, P <0.001). The ICG fluorescence guidance significantly decreased the LN non-compliance rates (33.9% vs. 55.1%, P =0.001). In 165 patients without baseline measurable LNs, ICG significantly increased the number of retrieved LNs and decreased the LN non-compliance rate (P <0.05). For 71 patients with baseline measurable LNs, the quality of lymphadenectomy significantly improved in those who had a complete response (P <0.05) but not in those who did not (P >0.05). Surgical outcomes were comparable between the groups (P >0.05). Conclusions: ICG can effectively improve the quality of lymphadenectomy in patients with LAGC who underwent laparoscopic radical gastrectomy after NAC.

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Current applications of indocyanine green (ICG) in abdominal, gynecologic and urologic surgery: a meta-review and quality analysis with use of the AMSTAR 2 instrument

Pantelis,

Machairiotis,

Stavros

et al. 2023

Surg Endosc

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Assessment of indocyanine green fluorescence lymphography on lymphadenectomy during minimally invasive gastric cancer surgery: a systematic review and meta-analysis

Cited by 15 publications

References 37 publications

Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review

Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: An Updated Systematic Review

Assessment of Laparoscopic Indocyanine Green Tracer-Guided Lymphadenectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

Current applications of indocyanine green (ICG) in abdominal, gynecologic and urologic surgery: a meta-review and quality analysis with use of the AMSTAR 2 instrument

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