Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지
DOI QR코드

DOI QR Code

Application of Near-Infrared Fluorescence Imaging with Indocyanine Green in Totally Laparoscopic Distal Gastrectomy

  • Liu, Maoxing (Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute) ;
  • Xing, Jiadi (Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute) ;
  • Xu, Kai (Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute) ;
  • Yuan, Peng (Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute) ;
  • Cui, Ming (Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute) ;
  • Zhang, Chenghai (Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute) ;
  • Yang, Hong (Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute) ;
  • Yao, Zhendan (Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute) ;
  • Zhang, Nan (Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute) ;
  • Tan, Fei (Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute) ;
  • Su, Xiangqian (Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute)
  • Received : 2020.04.24
  • Accepted : 2020.07.18
  • Published : 2020.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Recently, totally laparoscopic gastrectomy has been gradually accepted by surgeons worldwide for gastric cancer treatment. Complete dissection of the lymph nodes and the establishment of the surgical margin are the most important considerations for curative gastric cancer surgery. Previous studies have demonstrated that indocyanine green (ICG)-traced laparoscopic gastrectomy significantly improves the completeness of lymph node dissection. However, it remains difficult to identify the tumor location intraoperatively for gastric cancers that are staged ≤T3. Here, we investigated the feasibility of ICG fluorescence for lymph node mapping and tumor localization during totally laparoscopic distal gastrectomy. Materials and Methods: Preoperative and perioperative data from consecutive patients with gastric cancer who underwent a totally laparoscopic distal gastrectomy were collected and analyzed. The patients were categorized into the ICG (n=61) or the non-ICG (n=75) group based on whether preoperative endoscopic mucosal ICG injection was performed. Results: The ICG group had a shorter operation time and less intraoperative blood loss. Moreover, significantly more lymph nodes were harvested in the ICG group than the non-ICG group. No pathologically positive margin was found and there was no significant difference in either the proximal or distal surgical margins between the 2 groups. Conclusions: Near-infrared fluorescence imaging with ICG can be successfully used in totally laparoscopic distal gastrectomy, and it contributes to both the completeness of D2 lymph node dissection and confirmation of the gastric transection line. Well-designed prospective randomized studies are needed in the future to fully validate our findings.

Keywords

References

  1. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. Forthcoming 2020.
  2. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 2016;34:1350-1357. https://doi.org/10.1200/JCO.2015.63.7215
  3. Lee HJ, Hyung WJ, Yang HK, Han SU, Park YK, An JY, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg 2019;270:983-991. https://doi.org/10.1097/SLA.0000000000003217
  4. Wang Z, Xing J, Cai J, Zhang Z, Li F, Zhang N, et al. Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial. Surg Endosc 2019;33:33-45. https://doi.org/10.1007/s00464-018-6391-x
  5. Yu J, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: the CLASS-01 randomized clinical trial. JAMA 2019;321:1983-1992. https://doi.org/10.1001/jama.2019.5359
  6. Gong CS, Kim BS, Kim HS. Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: a single-center experience. World J Gastroenterol 2017;23:8553-8561. https://doi.org/10.3748/wjg.v23.i48.8553
  7. Jeong O, Jung MR, Park YK, Ryu SY. Safety and feasibility during the initial learning process of intracorporeal Billroth I (delta-shaped) anastomosis for laparoscopic distal gastrectomy. Surg Endosc 2015;29:1522-1529. https://doi.org/10.1007/s00464-014-3836-8
  8. Yan J, Zheng X, Liu Z, Yu J, Deng Z, Xue F, et al. A multicenter study of using carbon nanoparticles to show sentinel lymph nodes in early gastric cancer. Surg Endosc 2016;30:1294-1300. https://doi.org/10.1007/s00464-015-4358-8
  9. Li Z, Ao S, Bu Z, Wu A, Wu X, Shan F, et al. Clinical study of harvesting lymph nodes with carbon nanoparticles in advanced gastric cancer: a prospective randomized trial. World J Surg Oncol 2016;14:88. https://doi.org/10.1186/s12957-016-0835-3
  10. Luigiano C, Ferrara F, Morace C, Mangiavillano B, Fabbri C, Cennamo V, et al. Endoscopic tattooing of gastrointestinal and pancreatic lesions. Adv Ther 2012;29:864-873. https://doi.org/10.1007/s12325-012-0056-2
  11. Chung JW, Seo KW, Jung K, Park MI, Kim SE, Park SJ, et al. A promising method for tumor localization during total laparoscopic distal gastrectomy: preoperative endoscopic clipping based on negative biopsy and selective intraoperative radiography findings. J Gastric Cancer 2017;17:220-227. https://doi.org/10.5230/jgc.2017.17.e25
  12. Yano K, Nimura H, Mitsumori N, Takahashi N, Kashiwagi H, Yanaga K. The efficiency of micrometastasis by sentinel node navigation surgery using indocyanine green and infrared ray laparoscopy system for gastric cancer. Gastric Cancer 2012;15:287-291. https://doi.org/10.1007/s10120-011-0105-6
  13. Takeuchi H, Kitagawa Y. Sentinel node navigation surgery in patients with early gastric cancer. Dig Surg 2013;30:104-111. https://doi.org/10.1159/000350875
  14. Kitagawa Y, Takeuchi H, Takagi Y, Natsugoe S, Terashima M, Murakami N, et al. Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol 2013;31:3704-3710. https://doi.org/10.1200/JCO.2013.50.3789
  15. Kim TH, Kong SH, Park JH, Son YG, Huh YJ, Suh YS, et al. Assessment of the completeness of lymph node dissection using near-infrared imaging with indocyanine green in laparoscopic gastrectomy for gastric cancer. J Gastric Cancer 2018;18:161-171. https://doi.org/10.5230/jgc.2018.18.e19
  16. Chen QY, Xie JW, Zhong Q, Wang JB, Lin JX, Lu J, et al. Safety and efficacy of indocyanine green tracer-guided lymph node dissection during laparoscopic radical gastrectomy in patients with gastric cancer: a randomized clinical trial. JAMA Surg. Forthcoming 2020.
  17. Kwon IG, Son T, Kim HI, Hyung WJ. Fluorescent lymphography-guided lymphadenectomy during robotic radical gastrectomy for gastric cancer. JAMA Surg 2019;154:150-158. https://doi.org/10.1001/jamasurg.2018.4267
  18. Ushimaru Y, Omori T, Fujiwara Y, Yanagimoto Y, Sugimura K, Yamamoto K, et al. The feasibility and safety of preoperative fluorescence marking with indocyanine green (ICG) in laparoscopic gastrectomy for gastric cancer. J Gastrointest Surg 2019;23:468-476. https://doi.org/10.1007/s11605-018-3900-0
  19. Kim HI, Hyung WJ, Lee CR, Lim JS, An JY, Cheong JH, et al. Intraoperative portable abdominal radiograph for tumor localization: a simple and accurate method for laparoscopic gastrectomy. Surg Endosc 2011;25:958-963. https://doi.org/10.1007/s00464-010-1288-3
  20. Tokuhara T, Nakata E, Tenjo T, Kawai I, Satoi S, Inoue K, et al. A novel option for preoperative endoscopic marking with India ink in totally laparoscopic distal gastrectomy for gastric cancer: a useful technique considering the morphological characteristics of the stomach. Mol Clin Oncol 2017;6:483-486. https://doi.org/10.3892/mco.2017.1191
  21. Kim BS, Yook JH, Kim BS, Jung HY. A simplified technique for tumor localization using preoperative endoscopic clipping and radio-opaque markers during totally laparoscopic gastrectomy. Am Surg 2014;80:1266-1270. https://doi.org/10.1177/000313481408001231
  22. Park DJ, Lee HJ, Kim SG, Jung HC, Song IS, Lee KU, et al. Intraoperative gastroscopy for gastric surgery. Surg Endosc 2005;19:1358-1361. https://doi.org/10.1007/s00464-004-2217-0
  23. Xuan Y, Hur H, Byun CS, Han SU, Cho YK. Efficacy of intraoperative gastroscopy for tumor localization in totally laparoscopic distal gastrectomy for cancer in the middle third of the stomach. Surg Endosc 2013;27:4364-4370. https://doi.org/10.1007/s00464-013-3042-0
  24. Tummers QR, Boogerd LS, de Steur WO, Verbeek FP, Boonstra MC, Handgraaf HJ, et al. Near-infrared fluorescence sentinel lymph node detection in gastric cancer: a pilot study. World J Gastroenterol 2016;22:3644-3651. https://doi.org/10.3748/wjg.v22.i13.3644
  25. Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 2008;359:453-462. https://doi.org/10.1056/NEJMoa0707035
  26. Park YK, Yoon HM, Kim YW, Park JY, Ryu KW, Lee YJ, et al. Laparoscopy-assisted versus open D2 distal gastrectomy for advanced gastric cancer: results from a randomized phase II multicenter clinical trial (COACT 1001). Ann Surg 2018;267:638-645. https://doi.org/10.1097/SLA.0000000000002168
  27. Kim DW, Jeong B, Shin IH, Kang U, Lee Y, Park YS, et al. Sentinel node navigation surgery using near-infrared indocyanine green fluorescence in early gastric cancer. Surg Endosc 2019;33:1235-1243. https://doi.org/10.1007/s00464-018-6401-z
  28. Barreto SG, Sirohi B. Why should we perform a D2 lymphadenectomy in gastric cancer? Future Oncol 2017;13:2009-2012. https://doi.org/10.2217/fon-2017-0282
  29. Chang JS, Kim KH, Yoon HI, Hyung WJ, Rha SY, Kim HS, et al. Locoregional relapse after gastrectomy with D2 lymphadenectomy for gastric cancer. Br J Surg 2017;104:877-884. https://doi.org/10.1002/bjs.10502

Cited by

  1. Clinical implications of Indocyanine Green Fluorescence Imaging-Guided laparoscopic lymphadenectomy for patients with gastric cancer: A cohort study from two randomized, controlled trials using indivi vol.94, 2020, https://doi.org/10.1016/j.ijsu.2021.106120