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

Baiocchi, Gian Luca; Molfino, Sarah; Molteni, Beatrice; Quarti, L.M.; Arcangeli, G.; Manenti, Stefania; Arru, Luca; Botticini, Maristella; Gheza, Federico

doi:10.1007/s13304-020-00836-0

Cited by 42 publications

(22 citation statements)

References 22 publications

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“…Ongoing trials investigating the extent of lymphadenectomy after neoadjuvant therapy will allow to standardize the LN dissection from the multimodal therapy perspective (NCT02139605, NCT03961373). Fluorescence-guided lymphadenectomy is a new, feasible technique which allows to detect LN metastases within fluorescent LN stations [101,102] (Figure 1). Indocyanine green can improve the LN harvest and reduce LN noncompliance without increased complications in patients undergoing D2 lymphadenectomy [103].…”

Section: Nodal Status From the Surgical Perspectivementioning

confidence: 99%

Lymph Node Involvement in Advanced Gastric Cancer in the Era of Multimodal Treatment—Oncological and Surgical Perspective

Pelc

Skórzewska

Rawicz‐Pruszyński

et al. 2021

Cancers

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Gastric cancer (GC) continues to be one of the major oncological challenges on a global scale. The role of neoadjuvant chemotherapy (NAC) in GC is to downstage primary tumour, eliminate potential micrometastases, and increase the chance for radical resection. Although systemic treatment prolongs the survival in advanced GC, persistent lymph node (LN) metastases indicate poor prognosis. Further identification of prognostic factors after NAC is urgent and could positively influence clinical outcomes. This article aimed to review the actual trends and future perspectives in multimodal therapy of advanced GC, with a particular interest in the post-neoadjuvant pathological nodal stage. A favourable prognostic impact for ypN0 patients is observed, either due to truly negative LN before the start of therapy or because preoperative therapy achieved a pathologically complete nodal response. Ongoing trials investigating the extent of lymphadenectomy after neoadjuvant therapy will standardise the LN dissection from the multimodal therapy perspective. Since downstaged and primarily node-negative patients show a similar prognosis, the main target for NAC in advanced GC should be nodal clearance. Adequate staging and personalised perioperative therapy seem to be of great importance in the multimodal treatment of GC.

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Section: Nodal Status From the Surgical Perspectivementioning

confidence: 99%

Lymph Node Involvement in Advanced Gastric Cancer in the Era of Multimodal Treatment—Oncological and Surgical Perspective

Pelc

Skórzewska

Rawicz‐Pruszyński

et al. 2021

Cancers

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“…Herrera-Almario et al [ 6 ] found that subserosal injection of ICG helps surgeons visualize LNs effectively in robotic gastrectomy, thus improving the quality of lymphadenectomy. A retrospective study by Baiocchi et al [ 7 ] suggested that ICG tracer-guided LN dissection can be achieved either by submucosal or subserosal injection. Compared with submucosal injection 1 day before surgery, intraoperative subserosal injection before lymphadenectomy is theoretically more convenient for surgeons and can reduce the workload of endoscopists; however, it is associated with a possible risk of poor imaging.…”

Section: Introductionmentioning

confidence: 99%

Comparison of submucosal and subserosal approaches toward optimized indocyanine green tracer-guided laparoscopic lymphadenectomy for patients with gastric cancer (FUGES-019): a randomized controlled trial

Chen

Zhong

et al. 2021

BMC Med

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Background Application of indocyanine green (ICG) fluorescence imaging is effective in guiding laparoscopic radical lymphadenectomy for gastric cancer. However, the optimal approach for indocyanine green injection is controversial. Therefore, the objective of this study was aimed to compare the efficacy and ICG injection between the preoperative submucosal and intraoperative subserosal approaches for lymph node (LN) tracing during laparoscopic gastrectomy. Method This randomized controlled trial (ClinicalTrials.gov, NCT04219332) included 266 patients with potentially resectable gastric cancer (cT1–T4a, N0/+, M0) enrolled from a tertiary teaching center between December 2019 and October 2020. The primary endpoint was total number of retrieved LNs. Results In total, 259 patients (n = 130 and n = 129 in the submucosal and subserosal groups, respectively) were included in the per-protocol analysis. There are no significant differences in total number of retrieved LNs between the two groups (49.8 vs. 49.2, P = 0.713). The rate of LN noncompliance in the submucosal group was comparable to that in the subserosal group (32.3% vs. 33.3%, P = 0.860). No significant difference was found between the submucosal and subserosal groups in terms of the incidence (17.7% vs. 16.3%; P = 0.762) or severity of postoperative complications. The mean fluorescence cost in the submucosal group was higher than that in the subserosal group ($335.3 vs. $182.4; P < 0.001). The overall treatment satisfaction score was lower in the submucosal group than in the subserosal group (70.5 vs. 76.1%, P = 0.048). Conclusion ICG administered by subserosal injection was comparable to that administered by submucosal injection for lymph node tracing in gastric cancer. However, the former approach imposed a lower economic and mental burden on patients undergoing laparoscopic D2 lymphadenectomy. Trial registration ClinicalTrials.gov, NCT04219332.

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“…Recently developed surgical techniques (fluorescence-guided surgery) can assist the surgeon in making decisions about extended lymphadenectomy. 36 However, due to histological heterogeneity, tumor behavior throughout the clinical management of GC remains uncertain, thus novel diagnostic opportunities are highly desired for appropriate disease staging. Meanwhile, some studies in the field of metabolomics have been conducted to identify new potential biomarkers for early diagnosis of GC.…”

Section: Discussionmentioning

confidence: 99%

Kynurenine and Anthranilic Acid in the Peritoneum Correlate With the Stage of Gastric Cancer Disease

Gęca

Rawicz‐Pruszyński

Mlak

et al. 2022

Int J�Tryptophan�Res

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Background: This study aimed to assess the importance of selected kynurenines measured in peritoneal fluid, lavage washings, and blood serum in patients with advanced gastric cancer (GC) based on the clinical and pathological staging of TNM for a more precise evaluation of the stage of the disease. Methods: Data were collected from a prospectively maintained database of all patients operated on advanced GC between July 2018 and August 2020. In total, 98 patients were eligible for the analysis according to the REMARK guidelines. Results: Among the various kynurenines analyzed in this study, we found that the median concentration of anthranilic acid (AA) in the peritoneal lavage washings was significantly higher in patients with positive nodes (pN1-3) compared to those with negative nodes (pN0) ( P = 0.0100). Based on the ROC analysis, AA showed diagnostic utility in the differentiation of the pN staging ( P = 0.0047). Furthermore, there was a positive correlation between AA in peritoneal fluid with stage pN ( P = 0.0116) and a positive correlation between AA in peritoneal lavage washings with stage cT ( P = 0.0101). We found that the median concentration of kynurenine (Kyn) in peritoneal lavage washings was significantly higher in patients with cM1 compared to cM0 patients ( P = 0.0047). Based on the ROC analysis, Kyn showed diagnostic utility in cM staging differentiation ( P < 0.0001). There was a positive correlation between peritoneal Kyn and stage of cM ( P = 0.0079). Conclusions: AA and Kyn measured in peritoneal lavage indicate advanced GC and may be considered in the future as valuable adjunct tools in TNM staging of advanced GC.

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

Cited by 42 publications

References 22 publications

Lymph Node Involvement in Advanced Gastric Cancer in the Era of Multimodal Treatment—Oncological and Surgical Perspective

Lymph Node Involvement in Advanced Gastric Cancer in the Era of Multimodal Treatment—Oncological and Surgical Perspective

Comparison of submucosal and subserosal approaches toward optimized indocyanine green tracer-guided laparoscopic lymphadenectomy for patients with gastric cancer (FUGES-019): a randomized controlled trial

Kynurenine and Anthranilic Acid in the Peritoneum Correlate With the Stage of Gastric Cancer Disease

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