Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China.
West China School of Medicine, Sichuan University, Chengdu, China.
Surg Endosc. 2022 Mar;36(3):1726-1738. doi: 10.1007/s00464-021-08830-2. Epub 2022 Jan 25.
In recent years, indocyanine green fluorescence lymphography has been introduced for lymphatic mapping in gastric cancer surgery. The aim of this study was to investigate the efficacy of ICGFL in lymph node dissection during minimally invasive surgery for gastric cancer.
A systematic review of electronic databases including PubMed, Embase, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure was performed from the inception to January 2021 for all studies comparing ICGFL with non-ICGFL in GC patients undergoing minimal access gastrectomy. The primary outcome was the total number of harvested lymph nodes. The secondary endpoints were the number of metastatic LNs, operative time, estimated blood loss, and postoperative complications. The registration number of this protocol is PROSPERO CRD42020203443.
A total of 13 studies including 1882 participants were included. In this meta-analysis, the use of ICGFL was associated with a higher number of harvested LNs (40.33 vs. 33.40; MD = 6.93; 95%CI: 4.28 to 9.58; P < 0.0001; I = 86%). No significant difference was found between the ICGFL and control groups in terms of metastatic LNs (2.63 vs. 2.42; MD = 0.21; 95%CI: -0.46 to 0.87; P = 0.54; I = 0%). In addition, the use of ICGFL could be safely performed without increasing the operative time (P = 0.49), estimated blood loss (P = 0.26) and postoperative complications (P = 0.54).
The use of ICGFL may be a useful tool facilitating complete lymph node dissection during minimally invasive GC resection. However, more high-quality RCTs with large sample size are needed to validate this issue.
近年来，吲哚菁绿荧光淋巴成像已被引入胃癌手术中的淋巴作图。本研究旨在探讨吲哚菁绿荧光淋巴成像（ICGFL）在微创胃癌手术中淋巴结清扫的效果。
对从成立到 2021 年 1 月的 PubMed、Embase、Web of Science、Cochrane 图书馆和中国国家知识基础设施等电子数据库进行了系统评价，以比较接受微创胃切除术的 GC 患者中 ICGFL 与非 ICGFL 的所有研究。主要结局是总采集的淋巴结数量。次要终点是转移性淋巴结的数量、手术时间、估计出血量和术后并发症。本方案的注册号为 PROSPERO CRD42020203443。
共纳入 13 项研究，包括 1882 名参与者。在这项荟萃分析中，使用 ICGFL 与采集的淋巴结数量较多相关（40.33 对 33.40；MD=6.93；95%CI：4.28 至 9.58；P<0.0001；I=86%）。在转移性淋巴结方面，ICGFL 组与对照组之间无显著差异（2.63 对 2.42；MD=0.21；95%CI：-0.46 至 0.87；P=0.54；I=0%）。此外，使用 ICGFL 不会增加手术时间（P=0.49）、估计出血量（P=0.26）和术后并发症（P=0.54）。
ICGFL 的使用可能是微创 GC 切除术中完成淋巴结清扫的有用工具。然而，需要更多高质量、大样本量的 RCT 来验证这一问题。
