Laparoscopic sentinel node navigation surgery for early gastric cancer: a prospective multicenter trial

Takahashi, Naoto; Nimura, Hiroshi; Fujita, Tetsuji; Mitsumori, Norio; Shiraishi, Norio; Kitano, Seigo; Satodate, Hitoshi; Yanaga, Katsuhiko

doi:10.1007/s00423-016-1540-y

Cited by 50 publications

(36 citation statements)

References 20 publications

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“…To overcome disadvantages in conventional marking methods, we turned to ICG‐mediated imaging, which has been applied in sentinel lymph node navigation and orientation of the liver segments . During sentinel lymph node navigation, ICG is endoscopically injected into the submucosal layer of the stomach, which is similar to our method; several previous studies have reported the safety of this method .…”

Section: Discussionmentioning

confidence: 99%

Detection of indocyanine green fluorescence to determine tumor location during laparoscopic gastrectomy for gastric cancer: Results of a prospective study

Tanaka

Kanda

Funasaka

et al. 2019

Asian J Endoscop Surgery

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Introduction In laparoscopic gastrectomy, a method to locate the margin of an early‐stage cancerous lesion that is invisible from the serosal surface and impalpable during laparoscopic procedures is needed to determine an appropriate transection line. We conducted a prospective study to develop a new marking method using preoperative submucosal injection of indocyanine green (ICG). Methods Patients undergoing laparoscopic gastrectomy for T1 gastric cancer were recruited. The first 11 patients comprised the learning set and the subsequent 18 patients the validation set. ICG was endoscopically injected in the submucosal layer of the stomach approximately 1 cm away from the tumor edge 1 or 3 days before surgery. The diameters of the visualized ICG were compared with those of a conventional marking method using India ink in 10 historical controls. Results In the learning set, the optimal amount of ICG was determined to be 0.1 mL at a concentration of 0.5 mg/mL. In the validation set, the same procedure was repeated. No technical problems or adverse reactions related to ICG injection were observed. In all cases, ICG was successfully detected, and negative surgical margins were pathologically confirmed. The mean long diameter of the visualized ICG fluorescence measured at the mucosal surface of the stomach was significantly smaller in the current study than in the historical controls in whom India ink was used (21 vs 52 mm, P < 0.0001). Conclusions The preoperative submucosal ICG marking was safely performed and successfully detected without excessive blurring during laparoscopic gastrectomy.

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Section: Discussionmentioning

confidence: 99%

Detection of indocyanine green fluorescence to determine tumor location during laparoscopic gastrectomy for gastric cancer: Results of a prospective study

Tanaka

Kanda

Funasaka

et al. 2019

Asian J Endoscop Surgery

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“…The results of methodological quality that presented as percentages are summarized in Figure . However, “blinding design” was clearly described in only two studies …”

Section: Resultsmentioning

confidence: 99%

“…The dual method is considered the most reliable method, but it requires considerably more operative time, and the patient preparation is not a simple task . Fortunately, NIR or fluorescent ICG guided SLN mapping in GC has been conducted by various institutions and has yielded acceptable pooled sensitivity of 0.94 (95%C1: 0.80‐0.99), although a wide variation exists (0.40‐1.00) . Thus, this meta‐analysis is performed to evaluate the diagnostic value of NIR or fluorescent ICG guided SLN mapping in GC, and to identify factors of this diagnostic performance.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of near‐infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta‐analysis

Jiang

Wang

et al. 2018

Journal of Surgical Oncology

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Background This meta‐analysis was conducted to evaluate the diagnostic value of near‐infrared (NIR) or fluorescent indocyanine green (ICG) guided sentinel lymph node (SLN) mapping in gastric cancer (GC). Methods This meta‐analysis was registered at the PROSPERO. Clinical studies were retrieved from the electronic database Pubmed, Embase, Medline, Web of science, and the Cochrane Library. Quality assessment was conducted by an adapted checklist of QUADAS‐2. A bivariate mixed‐effects model was used to pool the data. Evaluation of articles quality, analysis for publication bias, summary receiver operator characteristic (SROC) curves, and meta‐regression were also performed. Subgroup analysis was used to explain the heterogeneities. Results A total of 13 clinical studies (971 patients) were included. The NIR or fluorescent imaging (FI) involved infrared ray electronic endoscopy (IREE), infrared ray laparoscopic system (IRLS), and FI system. Significant evidence of heterogeneity was found for sensitivity and specificity (I 2 = 91.1% and I 2 = 98.2%), respectively. The pooled SLN sensitivity (Sen), specificity (Spe), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 0.94(95%CI: 0.80‐0.99), 1.00(95%CI: 0.60‐1.00), 34.0(95%CI: 9.25‐125.29), 0.06(95%CI:0.02‐0.22), and 252.50(95%CI: 94.93‐671.61), respectively. Area under curve (AUC) of SROC curve was 1.00 (95%CI: 0.99‐1.00), and the summary operating point (cut‐off value) was SENS = 0.94(95%CI: 0.80‐0.99) and SPEC = 1.00(95%CI: 0.60‐1.00). Subgroup analysis showed that NIR imaging, imaging performed 20 minutes after intraoperative injection, preoperative injection (especially for FI imaging), stained with immunohistochemistry (IHC) (+hematoxylin‐eosin [HE]), cT1 stage, submucosa injection (especially for cT1), mean number of SLN ≥ 5, study size > 26 were associated with higher SLN sensitivity. In terms of ICG concentration, diluted ICG concentration that 0.5 mg/mL (compared with 5 mg/mL) in NIR imaging and 0.05 mg/mL (compared with 0.5 mg/mL) in FI system showed higher sensitivities. However, the differences in tumor diameter (≤30 mm vs >30 mm), gastrectomy methods (opening vs laparoscopy), lymphadenectomy methods (LBD vs pick‐up), and publication year (≥2010 vs <2010) did not achieve statistical significance. Conclusion ICG combined with NIR or FI guided SLN mapping is technically feasible for GC. Based on the small sample size evidence, the IREE and IRLS devices may have higher sensitivity than FI in current clinical studies; and there may be an excessive ICG concentration used for current SLN mapping in GC. However, well‐designed further studies with large sample size are needed to confirm the best procedure and suitable criteria. Mini‐abstract This meta‐analysis was registered at PROSPERO. Clinical studies on this topic were retrieved from the electronic database Pubmed, Embase, Medline, Web of Science, and the Cochrane Library. The NIR or FI involved IREE, IRLS, and FI techniques. A total of 13 clinical studies (9...

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“…Although further accumulation and analysis are necessary, we may be able to apply this method for avoiding unnecessary D2 dissection, intraoperative SN mapping and modified resection of laparoscopic gastric cancer surgey [21], [22], [23], [24].…”

Section: Discussionmentioning

confidence: 99%

New method of indocyanine green fluorescence sentinel node mapping for early gastric cancer

Ohdaira

Yoshida

Okada

et al. 2017

Annals of Medicine &Amp; Surgery

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BackgroundThe present study describes the retrospective feasibility study of ICG fluorescence SN mapping in back-table for early gastric cancer using PINPOINT®.MethodSN mapping were performed as following; the day before surgery, 0.5 ml ICG was injected endoscopically in four quadrants of the submucosa surrounding the gastric cancer using an endoscopic puncture. Intraoperatively, the gastrocolic ligament was divided to visualize all possible directions of lymphatic flow from the stomach. PINPOINT® (NOVADAQ, Canada) was used to illuminate regional lymph nodes from the serosal side. Positive staining was confirmed by at least 3 surgeons and an endoscopist during surgery (Figure 1). Lymph node dissection and gastrectomy were performed according to the criteria of gastric cancer treatment guidelines of JGCA.ResultAll 6 patients had gastrectomy with laparoscopic approach. ICG positive lymphatic flow and lymph nodes were able to be observed in all the patients. Final pathological diagnosis was all StageI and curative resection.All the patients had ICG positive lymphatic area in left gastric artery (LGA) area.Two patients with tumor located in L area had ICG positive flow to right gastroepipoloic artery (RGEA) area. The mean of ICG positive lymph nodes was 8.6. One patient had a metastatic lymph node in station No.4, which was positive for ICG.ConclusionOur method made identification of ICG positive lymph nodes easy in SN mapping in back-table under room light. Although further accumulation and analysis are necessary, we may be able to apply this method for intraoperative SN mapping of laparoscopic gastric cancer surgey.

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Laparoscopic sentinel node navigation surgery for early gastric cancer: a prospective multicenter trial

Abstract: The infrared ICG imaging accurately detected the lymphatic basin and SNs with occult metastasis in SN-navigated gastrectomy for gastric cancer. This method was feasible even for low-volume surgeons and hospitals.

Cited by 50 publications

References 20 publications

Detection of indocyanine green fluorescence to determine tumor location during laparoscopic gastrectomy for gastric cancer: Results of a prospective study

Detection of indocyanine green fluorescence to determine tumor location during laparoscopic gastrectomy for gastric cancer: Results of a prospective study

Diagnostic value of near‐infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta‐analysis

New method of indocyanine green fluorescence sentinel node mapping for early gastric cancer

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