Kim Tae-Han, Kong Seong-Ho, Park Ji-Ho, Son Yong-Gil, Huh Yeon-Ju, Suh Yun-Suhk, Lee Hyuk-Joon, Yang Han-Kwang
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea.
J Gastric Cancer. 2018 Jun;18(2):161-171. doi: 10.5230/jgc.2018.18.e19. Epub 2018 Jun 28.
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.
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).
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.
NIR imaging may provide additional node detection during laparoscopic LN dissection for gastric cancer, especially in the infra-pyloric area.
本研究评估了使用吲哚菁绿（ICG）的近红外（NIR）成像在研究胃癌腹腔镜淋巴结（LN）清扫完整性方面的可行性。
纳入计划接受腹腔镜胃癌切除术的患者。术中黏膜下注射ICG（0.05 mg/mL）后，在传统腹腔镜灯光下进行LN清扫。清扫后，在近红外模式下检查感兴趣的LN站，以定位任何额外的ICG染色（E）组织，将其切除并送病理确认。该技术分两步进行测试：幽门下LN清扫（步骤1）和根治性淋巴结清扫后对所有站的复查（步骤2）。
在步骤1中，检查了15例行腹腔镜保留幽门胃切除术（LPPG）的患者和15例行腹腔镜远端胃切除术（LDG）的患者。LPPG和LDG过程中分别获得7个和2个E组织。从回收的E组织中，LPPG和LDG过程中分别获得的1个和0个组织被确认为LN。在步骤2中，纳入20例患者（13例行D1 +清扫，7例行D2清扫）。从5例患者中回收了6个E组织，病理复查中有1个组织被确认为LN。总体而言，共检测并切除了15个E组织，病理复查中有2个组织被确认为LN。两个淋巴结均来自第6组LN站，LDG组和LPPG组各1例。
近红外成像可能在胃癌腹腔镜LN清扫过程中提供额外的淋巴结检测，尤其是在幽门下区域。
