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http://dx.doi.org/10.5230/jgc.2018.18.e19

Assessment of the Completeness of Lymph Node Dissection Using Near-infrared Imaging with Indocyanine Green in Laparoscopic Gastrectomy for Gastric Cancer  

Kim, Tae-Han (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Kong, Seong-Ho (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Park, Ji-Ho (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Son, Yong-Gil (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Huh, Yeon-Ju (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Suh, Yun-Suhk (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Lee, Hyuk-Joon (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Yang, Han-Kwang (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Publication Information
Journal of Gastric Cancer / v.18, no.2, 2018 , pp. 161-171 More about this Journal
Abstract
Purpose: This study assessed the feasibility of near-infrared (NIR) imaging with indocyanine green (ICG) in investigating the completeness of laparoscopic lymph node (LN) dissection for gastric cancer. Materials and Methods: Patients scheduled for laparoscopic gastrectomy for treating gastric cancer were enrolled in the study. After intraoperative submucosal ICG injection (0.05 mg/mL), LN dissection was performed under conventional laparoscopic light. After dissection, the LN stations of interest were examined under the NIR mode to locate any extra ICG-stained (E) tissues, which were excised and sent for pathologic confirmation. This technique was tested in 2 steps: infra-pyloric LN dissection (step 1) and review of all stations after proper radical node dissection (step 2). Results: In step 1, 15 patients who underwent laparoscopic pylorus-preserving gastrectomy (LPPG) and 15 patients who underwent laparoscopic distal gastrectomy (LDG) were examined. Seven and 2 E-tissues were obtained during LPPG and LDG, respectively. From the retrieved E-tissues, 1 and 0 tissue obtained during LPPG and LDG, respectively, was confirmed as LN. In step 2, 20 patients were enrolled (13 D1+ dissection and 7 D2 dissection). Six E-tissues were retrieved from 5 patients, and 1 tissue was confirmed as LN in the pathologic review. Overall, 15 E-tissues were detected and removed, and 2 tissues were confirmed as LNs in the pathologic review. Both nodes were from LN station #6, with 1 case each in the LDG and LPPG groups. Conclusions: NIR imaging may provide additional node detection during laparoscopic LN dissection for gastric cancer, especially in the infra-pyloric area.
Keywords
Indocyanine green; NIR; Diagnostic imaging; Lymph nodes; Gastric cancer;
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