Application of indocyanine green fluorescence imaging in totally laparoscopic distal-gastrectomy for gastric cancer / 中国肿瘤临床

ABSTRACT

Objective: To explore the value of indocyanine green fluorescence imaging in tumor localization and lymph node dissection in totally laparoscopic distal gastrectomy. Methods: A retrospective cohort study was used. The clinical and pathological data of 126 patients with distal gastric cancer diagnosed through gastroscopy and pathology dated from August 2017 to August 2019 in Peking University Cancer Hospital & Institute was collected. Among these 126 patients, 62 patients underwent laparoscopy with indocyanine green-labeled near-infrared fluorescence (observation group), and 64 patients underwent conventional laparoscopy (control group). The effects of preoperative indocyanine green-labeled, intraoperative endoscopic positioning and lymph node dissection were compared and evaluated between the two groups. Result: The distance of proximal incision margin was measured in patients with stage T1-2 gastric cancer. The observation group vs. the control group (4.92±1.65 cm vs. 4.76±1.66 cm, P=0.671). Number of second station lymph node dissection of patients with stage T3-4 gastric cancer in the observation group vs. the control group (11.09±6.19 vs. 8.89± 4.35, P=0.049); the number of damaged lymph nodes in the observation group vs. the control group (0.74±0.46 vs. 1.27±1.22, P= 0.009). Conclusions: The preoperative indocyanine green-fluorescence imaging in patients with stage T1-2 gastric cancer can accurately mark the tumor boundary, and its tumor localization effect is comparable with intraoperative gastroscopy in the surgery, which can guide the decision of the appropriate resection line during total laparoscopic surgery. Indocyanine green in the lymphatic navigation of T3-4 gastric cancer can guide the operation precisely and completely in the lymph node dissection, increase the number of lymph nodes dissection, and reduce the damage of lymph nodes during the operation.