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

Abstract

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.

Prognosis and Treatment of Gastric Cancer: A 2024 Update

“…As surgery takes place in multimodal treatments, being carried out after neoadjuvant chemotherapy, the matter of IG was analyzed in this population. Not only did IG increase the mean of the lymph nodes retrieved, but it also diminished the nodal non-compliance ratio [61]. Similar results were confirmed in patients with BMI ≥ 25 kg/m 2 [62].…”