Indocyanine Green Tracer-Guided Radical Robotic Distal Gastrectomy Using the Firefly™ System Improves the Quality of Lymph Node Dissection in Patients with Gastric Cancer

Fujimoto, Daisuke; Taniguchi, Koki; Takashima, Junpei; Kobayashi, Hirotoshi

doi:10.1007/s11605-023-05740-7

Journal of Gastrointestinal Surgery

2023

DOI: 10.1007/s11605-023-05740-7

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Indocyanine Green Tracer-Guided Radical Robotic Distal Gastrectomy Using the Firefly™ System Improves the Quality of Lymph Node Dissection in Patients with Gastric Cancer

Daisuke Fujimoto¹,

Koki Taniguchi²,

Junpei Takashima³

et al.

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2024

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Cited by 6 publications

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“…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. 14 Currently, the utility of ICG in D2 lymphadenectomy after NAC is still being explored.…”

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confidence: 99%

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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confidence: 99%

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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Assessment of diagnostic value of indocyanine green for lymph node metastasis in laparoscopic subtotal gastrectomy with D2 lymphadenectomy for gastric cancer: a prospective single-center study

Tuan,

Van Du

2024

Journal of Gastrointestinal Surgery

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Enhancing Lymph Node Yield in Gastric Cancer Resection: Impact of Back Table Dissection on Number of Lymph Node Examined

Wong,

Rawal,

Tseng

et al. 2024

The American Surgeon™

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Introduction During gastric cancer resection, back table dissection (BTD) involves examination and separation of lymph node (LN) packets from the surgical specimen based on LN stations, which are sent to pathology as separately labeled specimens. With potential impact on clinical outcomes, we aimed to explore how BTD affects number of LNs examined. Methods A retrospective review of a gastric cancer database was performed, including all cases of gastrectomy with D2 lymphadenectomy from January 2009 to March 2022. Back table dissection and conventional groups were compared using Mann-Whitney U and Fisher’s exact tests. Multiple linear regression modeling was used to identify potential predictors of number of LN examined. Results A total of 174 patients were identified: 39 (22%) BTD and 135 (78%) conventional. More patients in the BTD group underwent neoadjuvant chemotherapy (62% vs 29%, P < .05). Compared to the conventional group, the BTD group had a greater number of LNs examined (42 [26-59] vs 21[15-33], median [IQR], P < .001), lower LN positivity ratio (.01 vs .07, P = .013), and greater number of LNs in patients with BMI >35 (32.5[27.5-39] vs 22[13-27], P = .041). A multiple linear regression model controlling for age, BMI, preoperative N stage, neoadjuvant chemotherapy, surgeon experience, and operative approach identified BTD as a significant positive predictor of number of LN examined (β = 19.7, P = .001). Conclusion Back table dissection resulted in improved LN yield during gastric cancer resection. As a simple technical addition, BTD helps enhance pathology examination and improve surgeon awareness, which may ultimately translate to improve oncologic outcomes.

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Indocyanine Green Tracer-Guided Radical Robotic Distal Gastrectomy Using the Firefly™ System Improves the Quality of Lymph Node Dissection in Patients with Gastric Cancer

Cited by 6 publications

References 38 publications

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

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

Assessment of diagnostic value of indocyanine green for lymph node metastasis in laparoscopic subtotal gastrectomy with D2 lymphadenectomy for gastric cancer: a prospective single-center study

Enhancing Lymph Node Yield in Gastric Cancer Resection: Impact of Back Table Dissection on Number of Lymph Node Examined

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