ICG‐NIR‐guided lymph node dissection during robotic subtotal gastrectomy for gastric cancer. A single‐centre experience

Abstract

Background Near‐infrared (NIR) fluorescence imaging with indocyanine green (ICG) allows intraoperative visualisation of the lymph nodes (LNs) draining the tumour. Methods We included in our study 20 patients who underwent robotic subtotal gastrectomy + D2 lymphadenectomy for gastric cancer. In 10 cases, intraoperative ICG‐guided lymphography has been used (Group A). We compared the number of LNs retrieved with the use of NIR imaging and the number of LNs retrieved without the use of this technique (Group B, historical group). Results No complications related to ICG injection or near‐infrared imaging were observed. The mean number of overall LNs retrieved was significantly greater in Group A than in group B (40 vs. 24). No statistically significant difference in operative time was observed. Conclusions ICG‐guided fluorescent lymphography can help in performing a more accurate locoregional lymphadenectomy during robotic subtotal gastrectomy for gastric cancer. This technique represents a precious contribution to gastric cancer surgery.

The Use of Indocyanine Green (ICG) and Near-Infrared (NIR) Fluorescence-Guided Imaging in Gastric Cancer Surgery: A Narrative Review

“…These studies reported non-unique results and highlighted some limitations, including difficulties in resecting fluorescent stations that are usually not included in standard D2 lymphadenectomy (i.e., stations 13, 14v, or 16a). In contrast, some studies have shown a greater number of retrieved nodes in the critical stations of laparoscopic procedures that use NIR ICG (22,25,39,56).…”

“…Initially, it was used for the detection of sentinel lymph nodes in early gastric cancer ( 19 , 20 ). Its use has then been extended to preoperative endoscopic marking to assess tumor location, with the aim of achieving negative resection margins ( 21 ) and node mapping during D2 gastrectomy ( 22 – 22 ). The technique has also proven to be relevant in detecting anatomical structures, considering the complex anatomy of the perigastric vessels; it is also used in esophagogastric junction (EGJ) and esophageal tumors for the assessment of good perfusion of the anastomosis.…”

Safety and efficacy of indocyanine green near-infrared fluorescent imaging-guided lymph nodes dissection during radical gastrectomy for gastric cancer: A systematic review and meta-analysis

“…ICG injection is essential for efficient intraoperative LNs imaging ( 39 ). Most studies ( 15 , 22 – 24 , 26 – 29 , 34 , 35 ) used endoscopy for submucosal injection, which was performed around the primary tumor one day before surgery. The results of these studies showed that it could increase the overall number of recovered LNs without increasing surgery-related complications.…”

Lymph Node Mapping for Tumor Micrometastasis

“…Therefore, how to accurately and sufficiently dissect the lymph node in patients with gastric cancer remains a challenge even for experienced surgeon . Several studies have shown the potential of ICG mediated NIR fluorescence imaging for the accurate identification of a primary lesion …”

“…32 Several studies have shown the potential of ICG mediated NIR fluorescence imaging for the accurate identification of a primary lesion. 33 There are many advantages for ICG as a fluorescent tracer in gastric cancer, including its localization of the primary lesion, guidance for lymph node dissection, and sufficient tissue perfusion, providing important intraoperative information for surgeons. 34 One randomized clinical trial recently demonstrated the noticeable improvement in lymph node detection, which can effectively reduce lymph node complication compared with the conventional lymph node pathological examination, suggesting the safety and efficacy for the ICG-guided lymphadenectomy in gastric cancer.…”