Visualization of Lymphatic Flow in Laparoscopic Colon Cancer Surgery Using Indocyanine Green Fluorescence Imaging

Ushijima, Hokuto; Kawamura, Junichiro; Yane, Yoshinori; Yoshioka, Yasumasa; Daito, Koji; Tokoro, Tadao; Hida, Jin‐ichi; Okuno, Kiyotaka

doi:10.2139/ssrn.3378670

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“…As a result, ICG cannot be observed, or it may alter lymphatic flow from the tumor. Four of 57 patients with splenic flexure colon cancer who analyzed in our previous prospective study on the intraoperative detection of lymphatic flow and lymph nodes using ICG fluorescence imaging were included also in this study [ 38 ]. Three of these four patients who were pathologically diagnosed with stage N1a/b disease had ICG-positive lymph nodes along the left colic artery, middle colic artery, and left accessory aberrant colic artery (Fig.…”

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confidence: 99%

Laparoscopic complete mesocolic excision with central vascular ligation for splenic flexure colon cancer: short- and long-term outcomes

et al. 2021

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Background Complete mesocolic excision (CME) with central vascular ligation (CVL) for colon cancer is an essential procedure for improved oncologic outcomes after surgery. Laparoscopic surgery for splenic flexure colon cancer was recently adopted due to a greater understanding of surgical anatomy and improvements in surgical techniques and innovative surgical devices. Methods We retrospectively analyzed the data of patients with splenic flexure colon cancer who underwent laparoscopic CME with CVL at our institution between January 2005 and December 2017. Results Forty-five patients (4.8%) were enrolled in this study. Laparoscopic CME with CVL was successfully performed in all patients. The median operative time was 178 min, and the median estimated blood loss was 20 g. Perioperative complications developed in 6 patients (13.3%). The median postoperative hospital stay was 9 days. According to the pathological report, the median number of harvested lymph nodes was 15, and lymph node metastasis developed in 14 patients (31.1%). No metastasis was observed at the root of the middle colic artery or the inferior mesenteric artery. The median follow-up period was 49 months. The cumulative 5-year overall survival and disease-free survival rates were 85.9% and 84.7%, respectively. The cancer-specific survival rate in stage I-III patients was 92.7%. Recurrence was observed in 5 patients (11.1%), including three patients with peritoneal dissemination and two patients with distant metastasis. Conclusions Laparoscopic CME with CVL for splenic flexure colon cancer appears to be oncologically safe and feasible based on the short- and long-term outcomes in our study. However, it is careful to introduce this procedure to necessitate the anatomical understandings and surgeon’s skill. The appropriate indications must be established with more case registries because our experience is limited.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic complete mesocolic excision with central vascular ligation for splenic flexure colon cancer: short- and long-term outcomes

et al. 2021

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“…When ICG is exposed to near-infrared rays, it generates fluorescence. 2 IOFA has been widely used in other specialties, including ophthalmology, 3 gastrointestinal surgery, 4 and sentinel node mapping in breast cancer 5 ; however, application of this technology has been quite limited in cardiac surgery in general and in congenital cardiac surgery in particular. Here we present our experience using this technology.…”

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confidence: 99%

Intraoperative fluorescence with indocyanine green in congenital cardiac surgery: Potential applications of a novel technology

2021

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Background: Achieving successful repair of congenital heart defects requires attention to detail. Careful evaluation of anastomotic site patency, reimplanted coronary arteries, location of epicardial coronaries, and myocardial perfusion may be necessary to ensure safe conduct of the operation and achieve excellent outcomes.Methods: Intraoperative fluorescence angiography (IOFA) was performed using indocyanine green in patients undergoing the following procedures: coronary artery reimplantation, coronary artery unroofing, evaluation of intraoperative coronary anatomy, reoperation requiring ventriculotomy, coarctation/interrupted aortic arch repair, systemic-to-pulmonary artery shunt, Norwood procedure, thoracic duct localization, and vascular rings. Results:The technique was feasible in all patients. No mortality or adverse events related to the dye were encountered. Adequate intraoperative imaging was obtained in 15 patients (20 images), which correlated well with postoperative studies. The imaging quality was superior for assessing shunt patency, myocardial perfusion, and anastomotic patency and determining the location of epicardial coronary arteries but was less so for assessing branch pulmonary arteries.Conclusions: IOFA is a useful and safe technique that can provide a quick on-table assessment of a variety of congenital surgical procedures. This may help answer questions that can minimize postoperative interventions and help ensure a smooth perioperative course and excellent outcomes. (JTCVS Techniques 2021;-:1-12)Right modified Blalock-Taussig shunt as visualized in a patient with double-outlet right ventricle/pulmonary atresia.

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Visualization of Lymphatic Flow in Laparoscopic Colon Cancer Surgery Using Indocyanine Green Fluorescence Imaging

Cited by 2 publications

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Laparoscopic complete mesocolic excision with central vascular ligation for splenic flexure colon cancer: short- and long-term outcomes

Laparoscopic complete mesocolic excision with central vascular ligation for splenic flexure colon cancer: short- and long-term outcomes

Intraoperative fluorescence with indocyanine green in congenital cardiac surgery: Potential applications of a novel technology

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