Intra-Nodal Indocyanine Green Injection to Delineate Thoracic Duct During Minimally Invasive Esophagectomy

Varshney, Vaibhav Kumar; Nayar, Raghav; Soni, S. K.; Selvakumar, B; Garg, Pawan Kumar; Varshney, Peeyush; Khera, Pushpinder Singh

doi:10.1007/s11605-022-05341-w

Cited by 10 publications

(11 citation statements)

References 17 publications

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“…Furthermore, rapid imaging of R2SM in the tumor regions (Figure S23) demonstrated the capability of its potential usage in intraoperative imaging, as the time for tumor visualization (0.5 h p.i.) of R2SM is in correspondence with the time of reported clinical imaging agents. − …”

Section: Resultsmentioning

confidence: 78%

Acidity-Triggered “Sticky Spotlight”: CCK2R-Targeted TME-Sensitive NIR Fluorescent Probes for Tumor Imaging In Vivo

Sun,

Wang,

Shi

et al. 2024

Bioconjugate Chem.

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Cancer which causes high mortality globally threatens public health seriously. There is an urgent need to develop tumor-specific near-infrared (NIR) imaging agents to achieve precise diagnosis and guide effective treatment. In recent years, imaging probes that respond to acidic environments such as endosomes, lysosomes, or acidic tumor microenvironments (TMEs) are being developed. However, because of their nonspecific internalization by both normal and tumor cells, resulting in a poor signal-to-noise ratio in diagnosis, these pH-sensitive probes fail to be applied to in vivo tumor imaging. To address this issue, a cholecystokinin-2 receptor (CCK2R)-targeted TME-sensitive NIR fluorescent probe R2SM was synthesized by coupling pH-sensitive heptamethine cyanine with a CCK2R ligand, minigastrin analogue 11 (MG11) for in vivo imaging, in which MG11 would target overexpressed CCK2Rs in gastrointestinal stromal tumors (GISTs). Cell uptake assay demonstrated that R2SM exhibited a high affinity for CCK2R, leading to receptormediated internalization and making probes finally accumulated in the lysosomes of tumor cells, which suggested in the tumor tissues, the probes were distributed in the extracellular acidic TME and intracellular lysosomes. With a pK a of 6.83, R2SM can be activated at the acidic TME (pH = 6.5−6.8) and lysosomes (pH = 4.5−5.0), exhibiting an apparent pH-dependent behavior and generating more intense fluorescence in these acidic environments. In vivo imaging showed that coupling of MG11 with a pHsensitive NIR probe facilitated the accumulation of probe and enhanced the fluorescence in CCK2R-overexpressed HT-29 tumor cells. A high signal was observed in the tumor region within 0.5 h postinjection, indicating its potential application in intraoperative imaging. Fluorescence imaging of R2SM exhibited higher tumor-to-liver and tumor-to-kidney ratios (2.1:1 and 2.3:1, respectively), compared separately with the probes that are lipophilic, pH-insensitive, or MG11-free. In vitro and in vivo studies demonstrated that the synergistic effect of tumor targeting with pH sensitivity plays a vital role in the high signal-to-noise ratio of the NIR imaging probe. Moreover, different kinds of tumor-targeting vectors could be conjugated simultaneously with the NIR dye, which would further improve the receptor affinity and targeting efficiency.

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Section: Resultsmentioning

confidence: 78%

Acidity-Triggered “Sticky Spotlight”: CCK2R-Targeted TME-Sensitive NIR Fluorescent Probes for Tumor Imaging In Vivo

Sun,

Wang,

Shi

et al. 2024

Bioconjugate Chem.

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“…As the thoracic duct is known for frequent variation, 9 the chance of failure, in the case of anomalous thoracic duct, was there. Recent studies have shown successful identification of the thoracic duct with a near‐infrared imaging system by preoperative injection of indocyanine green dye in inguinal nodes under the guidance of ultrasound 10,11 . However, this system is not available in many centers, especially in developing nations.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic transhiatal en‐mass thoracic duct ligation for persistent bilateral spontaneous Chylothorax: A case report

Deo,

Gautam

et al. 2024

Clinical Case Reports

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Key Clinical MessageChylothorax is a rare entity associated with morbidity. Surgical thoracic duct ligation (TDL) by thoracoscopic approach is the recommended choice for persistent chylothorax. However, thoracoscopy is not feasible in case of previous pleurodesis. We describe a successful laparoscopic transhiatal en‐mass TDL in a 61‐year‐old lady for persistent spontaneous chylothorax after failed optimal conservative management and three sessions of pleurodesis. The study shows that laparoscopic transhiatal thoracic duct ligation is an effective alternative in a case where thoracoscopy is not feasible due to various reasons.

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“…Despite these technical improvements, the incidence of CT remains similar to that of open esophagectomy. 7 CT is a rare but potentially life-threatening complication that can lead to respiratory and metabolic problems. 8,9 Loss of chyle impairs wound healing due to protein loss and weight gain due to loss of fat.…”

Section: Discussionmentioning

confidence: 99%

“…Esophagectomy is currently the only potentially curative treatment for esophageal cancer, but it is associated with high morbidity (50%) and mortality, even in high-volume centers. 7 In recent decades, minimally invasive procedures for esophagectomy have been developed to minimize surgical trauma and complication rates. Despite these technical improvements, the incidence of CT remains similar to that of open esophagectomy.…”

Section: Discussionmentioning

confidence: 99%

Thoracic duct identification with indocyanine green fluorescence to prevent chyle leaks during minimally invasive esophagectomy

Mahmoodzadeh,

Farahzadi,

Omranipour

et al. 2024

Cancer Reports

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IntroductionChylothorax (CT) is a rare yet serious complication after esophagectomy. Identification of the thoracic duct (TD) during esophagectomy is challenging due to its anatomical variation. Real‐time identification of TD may help to prevent its injury. Near infra‐red imaging with Indocyanine green (ICG) is a novel technique that recently has been used to overcome this issue.MethodsPatients who underwent minimally invasive esophagectomy for esophageal cancer were divided into two groups with and without ICG. We injected ICG into bilateral superficial inguinal lymph nodes. Identification of TD and its injuries during the operation was evaluated and compared with the non‐ICG group.ResultsEighteen patients received ICG, and 18 patients underwent surgery without ICG. Each group had one (5.5%) TD ligation. In the ICG group injury was detected intraoperative, and ligation was done at the site of injury. In all cases, the entire thoracic course of TD was visualized intraoperatively after a mean time of 81.39 min from ICG injection to visualization. The Mean extra time for ICG injection was 11.94 min. In the ICG group, no patient suffered from CT. One patient in the non‐ICG group developed CT after surgery that was managed conservatively. According to Fisher's exact test, there was no significant association between CT development and ICG use, possibly due to the small sample size.ConclusionsThis study confirms that ICG administration into bilateral superficial inguinal lymph nodes can highlight the TD and reduce its damage during esophagectomy. It can be a standard method for the prevention of postoperative CT.

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Intra-Nodal Indocyanine Green Injection to Delineate Thoracic Duct During Minimally Invasive Esophagectomy

Cited by 10 publications

References 17 publications

Acidity-Triggered “Sticky Spotlight”: CCK2R-Targeted TME-Sensitive NIR Fluorescent Probes for Tumor Imaging In Vivo

Acidity-Triggered “Sticky Spotlight”: CCK2R-Targeted TME-Sensitive NIR Fluorescent Probes for Tumor Imaging In Vivo

Laparoscopic transhiatal en‐mass thoracic duct ligation for persistent bilateral spontaneous Chylothorax: A case report

Thoracic duct identification with indocyanine green fluorescence to prevent chyle leaks during minimally invasive esophagectomy

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