Lee Sejin, Song Jeong Ho, Choi Seohee, Cho Minah, Kim Yoo Min, Kim Hyoung-Il, Hyung Woo Jin
Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea.
Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.
Surg Endosc. 2022 May;36(5):2914-2924. doi: 10.1007/s00464-021-08584-x. Epub 2021 Jun 9.
Fluorescent lymphography is an excellent technique for complete lymph node dissection during minimally invasive surgery for gastric cancer. This study aimed to evaluate the role of fluorescent lymphography in splenic hilar lymph node dissection during minimally invasive total gastrectomy.
We retrospectively analyzed 168 gastric cancer patients who underwent minimally invasive total gastrectomy with D2 + No. 10 lymph node dissection from 2013 to 2018. Fluorescent lymphography was used whenever it is possible. However, when near-infrared imaging system and endoscopic indocyanine green injection were not available, we performed surgery without fluorescent lymphography. A total of 74 patients underwent surgery with fluorescent lymphography (FL group) and 94 underwent surgery without it (non-FL group). Perioperative and long-term outcomes including the number of retrieved lymph nodes at each nodal station were compared between groups.
The median number of retrieved lymph nodes at the splenic hilum was larger in the FL group {2.5 [Interquartile range (IQR), 1-5]} than in the non-FL group [1 (IQR, 1-3); P = 0.012]. The negative predictive value of fluorescent lymphography for lymph node metastasis at the splenic hilum was 97.1%, although the sensitivity was 66.7%. The overall survival (FL: 96.9% vs. non-FL: 88.9%; P = 0.334) and relapse-free survival (FL: 90.5% vs. non-FL: 65.5%; P = 0.054) were higher in the FL group, although there were no statistical differences. However, among the patients without lymph node metastasis, the relapse-free survival was significantly higher in the FL group (100%) than in the non-FL group (67.1%; P = 0.017).
Fluorescent lymphography is an effective tool for complete lymph node dissection at the splenic hilum. Moreover, it may help select patients who do not need splenic hilar lymph node dissection during a total gastrectomy.
荧光淋巴造影术是胃癌微创手术中进行完全淋巴结清扫的一项出色技术。本研究旨在评估荧光淋巴造影术在微创全胃切除术中脾门淋巴结清扫中的作用。
我们回顾性分析了2013年至2018年期间接受微创全胃切除并进行D2 + 第10组淋巴结清扫的168例胃癌患者。只要有可能，就使用荧光淋巴造影术。然而，当无法使用近红外成像系统和内镜注射吲哚菁绿时，我们在没有荧光淋巴造影术的情况下进行手术。共有74例患者接受了荧光淋巴造影术手术（FL组），94例患者未接受该手术（非FL组）。比较两组的围手术期和长期结局，包括各淋巴结站的回收淋巴结数量。
FL组脾门回收淋巴结的中位数{2.5 [四分位数间距（IQR），1 - 5]}高于非FL组[1（IQR，1 - 3）；P = 0.012]。荧光淋巴造影术对脾门淋巴结转移的阴性预测值为97.1%，尽管敏感性为66.7%。FL组的总生存率（FL：96.9% vs. 非FL：88.9%；P = 0.334）和无复发生存率（FL：90.5% vs. 非FL：65.5%；P = 0.054）较高，尽管无统计学差异。然而，在无淋巴结转移的患者中，FL组的无复发生存率（100%）显著高于非FL组（67.1%；P = 0.017）。
荧光淋巴造影术是脾门完全淋巴结清扫的有效工具。此外，它可能有助于选择在全胃切除术中不需要进行脾门淋巴结清扫的患者。
