Transrectal sentinel lymph node biopsy for early rectal cancer during transanal endoscopic microsurgery

Arezzo, Alberto; Arolfo, Simone; Mistrangelo, Massimiliano; Mussa, Baudolino; Cassoni, Paola; Morino, Mario

doi:10.3109/13645706.2013.789061

Cited by 15 publications

(7 citation statements)

References 23 publications

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“…Recently, some authors have described the use of ICG to identify sentinel lymph nodes [35][36][37][38][39][40][41] in colorectal cancer surgery: an intraoperative or immediately preoperative IGC submucosal or subserosal ICG injection was realized, with a consequent rapid visualization with fluorescence imaging of sentinel nodes.…”

Section: Fluorescence For D3 Lymphadenectomymentioning

confidence: 99%

Fluorescence‐guided D3 lymphadenectomy in robotic right colectomy with complete mesocolic excision

Petz

Bertani

Borin

et al. 2021

Robotics Computer Surgery

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Background In robotic right hemicolectomy for cancer, appropriate lymphadenectomy is essential. Visualization of draining lymph nodes and blood flow with near‐infrared (NIR) fluorescence DaVinci® imaging system is a recent development. We present the technique of robotic right colectomy with complete mesocolic excision (CME) and D3 lymphadenectomy using Indocyanine Green (ICG) endoscopic submucosal injection to intraoperatively identify tumour lymphatic basin. Methods The day before surgery, in patients scheduled for robotic right colectomy an endoscopic submucosal injection of 3 mg of ICG solution around the tumor is realized. Robotic right hemicolectomy is performed with suprapubic trocars layout and “bottom to up dissection”, realizing a CME with central vessel ligation and D3 lymphadenectomy. Site of primary tumor and lymphatic basin are visible with the FireflyTM camera modality. Results From July 2016 to July 2020, 85 patients received a robotic right colectomy with CME and D3 lymphadenectomy. In 50 patients, ICG submucosal injection was performed: visualisation of the site of primary tumour and of LN in the D3 area was possible in all cases; in 17/50 patients (34%), LN out from anatomical lymphatic basin were identified. No side effects were observed. Conclusions In this series, submucosal ICG injection showed to be feasible and safe. The accuracy in identification of D3 lymphatic basin was high, thus permitting an image‐guided radical lymphadenectomy. Fluorescent technology represents an interesting innovation to ameliorate surgery of colon cancer.

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Section: Fluorescence For D3 Lymphadenectomymentioning

confidence: 99%

Fluorescence‐guided D3 lymphadenectomy in robotic right colectomy with complete mesocolic excision

Petz

Bertani

Borin

et al. 2021

Robotics Computer Surgery

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“…It is further used to define resection margins for oncological resections, but also resection planes for living donor liver transplantations [ 13 ]. Additional indications for the use of ICG are bleeding or perfusion control, i.e., in esophageal or colorectal surgery, and lymph node detection [ 13 , 52 , 53 , 54 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of ICG in Robot-Assisted Liver Resections

Mehdorn

Richter

Heß

et al. 2022

JCM

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Introduction: Robotic-assisted liver surgery (RALS) with its known limitations is gaining more importance. The fluorescent dye, indocyanine green (ICG), is a way to overcome some of these limitations. It accumulates in or around hepatic masses. The integrated near-infrared cameras help to visualize this accumulation. We aimed to compare the influence of ICG staining on the surgical and oncological outcomes in patients undergoing RALS. Material and Methods: Patients who underwent RALS between 2014 and 2021 at the Department of General Surgery at the University Hospital Schleswig-Holstein, Campus Kiel, were included. In 2019, ICG-supported RALS was introduced. Results: Fifty-four patients were included, with twenty-eight patients (50.9%) receiving preoperative ICG. Hepatocellular carcinoma (32.1%) was the main entity resected, followed by the metastasis of colorectal cancers (17%) and focal nodular hyperplasia (15.1%). ICG staining worked for different tumor entities, but diffuse staining was noted in patients with liver cirrhosis. However, ICG-supported RALS lasted shorter (142.7 ± 61.8 min vs. 246.4 ± 98.6 min, p < 0.001), tumors resected in the ICG cohort were significantly smaller (27.1 ± 25.0 mm vs. 47.6 ± 35.2 mm, p = 0.021) and more R0 resections were achieved by ICG-supported RALS (96.3% vs. 80.8%, p = 0.075). Conclusions: ICG-supported RALS achieve surgically and oncologically safe results, while overcoming the limitations of RALS.

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“…Similarly, Arezzo et al performed a transrectal sentinel lymph node biopsy for early rectal cancer during transanal endoscopic microsurgery using the NIR ICG reporting a 100% detection rate on three patients [35].…”

Section: Discussionmentioning

confidence: 99%

Upstaging nodal status in colorectal cancer using ex vivo fluorescence sentinel lymph node mapping: preliminary results

Picchetto

Diana

Swanström

et al. 2020

Minimally Invasive Therapy & Allied Technologies

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Background: Sentinel lymph node (SLN) mapping using near-infrared fluorescence (NIRF) imaging is a recent technique to improve nodal staging in several tumors. The presence of colorectal cancer (CRC) micro-metastases has recently been defined as N1 disease and no longer as N1mi, determining the need for adjuvant chemotherapy. In CRC, the reported rate of SLN micro-metastases detected by ultrastaging techniques is as high as 30%. The aim of this prospective study is to report the preliminary results of the sensitivity analysis of NIRF imaging for ex vivo SLN mapping and the research of micro-metastases in CRC, in patients with node-negative disease (NND). Material and methods: On the specimen of 22 CRC patients, 1 mL of ICG (5 mg/mL) was injected submucosally around the tumor to identify SLNs. NND SLNs were further investigated with ultrastaging techniques. Results: Three-hundred and sixty-three lymph nodes were retrieved (59 SLNs; mean per case: 2.7). The detection, sensitivity and false-negative rate were 100%, 100% and 0% respectively. Ultrastaging investigations showed no micro-metastases in the NND SLNs. Conclusions: The ex vivo SLN fluorescence-based detection in CRC was confirmed to be easy to perform and reliable. In this preliminary results report of an ongoing study, the SLN assay was congruent with the nodal status, as confirmed by histological investigations.

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Transrectal sentinel lymph node biopsy for early rectal cancer during transanal endoscopic microsurgery

Cited by 15 publications

References 23 publications

Fluorescence‐guided D3 lymphadenectomy in robotic right colectomy with complete mesocolic excision

Fluorescence‐guided D3 lymphadenectomy in robotic right colectomy with complete mesocolic excision

The Role of ICG in Robot-Assisted Liver Resections

Upstaging nodal status in colorectal cancer using ex vivo fluorescence sentinel lymph node mapping: preliminary results

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