The Clinical Value of Fluorescent Lymphography with Indocyanine Green During Robotic Surgery for Gastric Cancer: a Match
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ORIGINAL ARTICLE
The Clinical Value of Fluorescent Lymphography with Indocyanine Green During Robotic Surgery for Gastric Cancer: a Matched Cohort Study Fabio Cianchi 1 & Giampiero Indennitate 2 & Beatrice Paoli 2 & Manuela Ortolani 2 & Gabriele Lami 3 & Natalia Manetti 3 & Ottaviano Tarantino 4 & Sara Messeri 4 & Caterina Foppa 5 & Benedetta Badii 1 & Luca Novelli 6 & Ileana Skalamera 1 & Tommaso Nelli 1 & Francesco Coratti 1 & Giuliano Perigli 1 & Fabio Staderini 1 Received: 12 June 2019 / Accepted: 26 August 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Background Near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has been recently introduced for lymphatic mapping in several tumors. We aimed at investigating whether this technology may improve the intraoperative visualization of lymph nodes during robotic gastrectomy for gastric cancer. Methods Between June 2014 and June 2018, a total of 94 patients underwent robotic gastrectomy with D2 lymph node dissection for gastric cancer. In 37 patients, ICG was injected endoscopically into the submucosal layer around the tumor the day before surgery. After propensity score matching, the results of these 37 patients were compared with the results of 37 control patients who had undergone robotic gastrectomy without ICG injection. Results Among the 37 patients within the ICG group, no adverse events related to ICG injection or intraoperative NIR imaging occurred. After completion of D2 lymph node dissection, no residual fluorescent lymph nodes were left in the surgical field. A mean of 19.4 ± 14.7 fluorescent lymph nodes was identified per patient. The mean total number of harvested lymph nodes was significantly higher in the ICG group than in the control group (50.8 vs 40.1, P = 0.03). In the ICG group, 23 patients had metastatic lymph nodes. The accuracy, sensitivity, and specificity of ICG fluorescence for metastatic lymph nodes were 62.2%, 52.6%, and 63.0%, respectively. Conclusion Our study indicates that NIR imaging with ICG may provide additional node detection during robotic surgery for gastric cancer. Unfortunately, this technique failed to show good selectivity for metastatic lymph nodes. Keywords Near-infrared fluorescence . Indocyanine green . Lymph node . Robotic gastrectomy . Gastric cancer
Introduction * Fabio Cianchi [email protected] 1
Center for Oncological Minimally Invasive Surgery (COMIS), Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
2
IFCA, Florence, Italy
3
Gastroenterology Unit, Careggi University Hospital, Florence, Italy
4
Gastroenterology Unit, San Giuseppe Hospital, Empoli, Italy
5
Humanitas Clinical and Research Hospital, Milan, Italy
6
Pathology Unit, Careggi University Hospital, Florence, Italy
Minimally invasive surgery, including laparoscopic and robotic approaches, has emerged as a valid option for the treatment of gastric cancer, especially in the East and for patients with early-stage tumors.1 However, the onc
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