腹腔镜胃癌手术中吲哚菁绿荧光成像引导前哨淋巴结定位。
Sentinel node mapping guided by indocyanine green fluorescence imaging during laparoscopic surgery in gastric cancer.
机构信息
Department of Surgery, Showa University, Tokyo, Japan.
出版信息
Ann Surg Oncol. 2010 Jul;17(7):1787-93. doi: 10.1245/s10434-010-0944-0. Epub 2010 Feb 17.
BACKGROUND
Indocyanine green (ICG) fluorescence imaging has recently been reported as a new method for sentinel node (SN) mapping in several types of cancers. In this study, we determined the possible usefulness of SN mapping guided by ICG fluorescence imaging during laparoscopy-assisted gastrectomy (LAG) for gastric cancer.
METHODS
Our series consisted of 77 patients with cT1- or cT2-stage gastric cancer who had undergone LAG (LAG group; 38 patients) or conventional open gastrectomy (OG group; 39 patients). Intraoperative SN mapping guided by ICG fluorescence imaging was conducted with a charge-coupled device camera with a light-emitting diode as the light source and a cut filter as the detector.
RESULTS
The detection rate and mean number of fluorescent nodes (FNs) were 94.7% and 7.9, respectively, in the LAG group, and 94.9% and 7.2, respectively, in the OG group. The accuracy and false-negative rates were 97.2% (35 of 36 cases) and 25% (1 of 4), respectively, in the LAG group, and 91.9% (34 of 37) and 23.1% (3 of 13), respectively, in the OG group. Among 33 LAG group patients and 27 OG group patients without FN metastasis, lymph node metastasis was found only in non-SNs located in the same lymphatic basin as the detected FNs.
CONCLUSIONS
SN mapping guidance by ICG fluorescence imaging could be useful for predicting the lymph node metastasis in gastric cancer, even during LAG. Our data suggest that dissection of the lymphatic basin containing FNs with laparoscopic surgery may be a promising approach as a new type of minimally invasive surgery for patients with cT1- or cT2-stage gastric cancer having no metastasis in FNs.
背景
吲哚菁绿（ICG）荧光成像最近被报道为几种癌症中前哨淋巴结（SN）定位的新方法。在这项研究中，我们确定了腹腔镜辅助胃切除术（LAG）中 SN 成像指导下 ICG 荧光成像在胃癌中的可能用途。
方法
我们的系列研究包括 77 例 cT1 或 cT2 期胃癌患者，他们接受了 LAG（LAG 组，38 例）或传统开腹胃切除术（OG 组，39 例）。术中 SN 成像由带发光二极管作为光源的电荷耦合器件（CCD）相机和带滤光片的探测器引导。
结果
LAG 组的检测率和平均荧光节点（FN）数分别为 94.7%和 7.9，OG 组分别为 94.9%和 7.2。LAG 组的准确率和假阴性率分别为 97.2%（35/36 例）和 25%（1/4），OG 组分别为 91.9%（34/37）和 23.1%（3/13）。在 33 例 LAG 组患者和 27 例无 FN 转移的 OG 组患者中，仅在与检测到的 FN 位于同一淋巴结引流区的非 SN 中发现淋巴结转移。
结论
ICG 荧光成像引导 SN 成像可用于预测胃癌的淋巴结转移，甚至在 LAG 中也是如此。我们的数据表明，对包含 FN 的淋巴结引流区进行腹腔镜手术解剖可能是一种很有前途的方法，作为一种新的微创术式，适用于无 FN 转移的 cT1 或 cT2 期胃癌患者。
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