Ng Calvin Sze-Hang, Ong Boon-Hean, Chao Yin Kai, Wright Gavin M, Sekine Yasuo, Wong Ian, Hao Zhexue, Zhang Guangjian, Chaturvedi Harit, Thammineedi Subramanyeshwar Rao, Law Simon, Kim Hyun Koo
Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore.
Ann Thorac Surg. 2023 Apr;115(4):1068-1076. doi: 10.1016/j.athoracsur.2022.06.061. Epub 2022 Aug 27.
Fluorescence imaging using indocyanine green in thoracic and esophageal surgery is gaining popularity because of the potential to facilitate surgical planning, to stage disease, and to reduce postoperative complications. To optimize use of fluorescence imaging in thoracic and esophageal surgery, an expert panel sought to establish a set of recommendations at a consensus meeting.
The panel included 12 experts in thoracic and upper gastrointestinal surgery from Asia-Pacific countries. Before meeting, 7 focus areas were defined: intersegmental plane identification for sublobar resections; pulmonary nodule localization; lung tumor detection; bullous lesion detection; lymphatic mapping of lung tumors; evaluation of gastric conduit perfusion; and lymphatic mapping in esophageal surgical procedures. A literature search of the PubMed database was conducted using keywords indocyanine green, fluorescence, thoracic, surgery, and esophagectomy. At the meeting, panelists addressed each focus area by discussing the most relevant evidence and their clinical experiences. Consensus statements were derived from the proceedings, followed by further discussions, revisions, finalization, and unanimous agreement. Each statement was assigned a level of evidence and a grade of recommendation.
A total of 9 consensus recommendations were established. Identification of the intersegmental plane for sublobar resections, localization of pulmonary nodules, lymphatic mapping in lung tumors, and assessment of gastric conduit perfusion were applications of fluorescence imaging that have the most robust current evidence.
Based on best available evidence and expert opinions, these consensus recommendations may facilitate thoracic and esophageal surgery using fluorescence imaging.
在胸外科和食管外科手术中使用吲哚菁绿进行荧光成像正日益受到欢迎，因为它有潜力促进手术规划、疾病分期并减少术后并发症。为了优化荧光成像在胸外科和食管外科手术中的应用，一个专家小组在一次共识会议上寻求制定一套建议。
该小组包括来自亚太国家的12位胸外科和上消化道外科专家。在会议召开前，确定了7个重点领域：亚肺叶切除术中节段间平面的识别；肺结节定位；肺肿瘤检测；肺大疱病变检测；肺肿瘤的淋巴绘图；胃代食管灌注评估；以及食管手术中的淋巴绘图。使用关键词吲哚菁绿、荧光、胸外科、手术和食管切除术在PubMed数据库中进行文献检索。在会议上，小组成员通过讨论最相关的证据及其临床经验来探讨每个重点领域。从会议记录中得出共识声明，随后进行进一步讨论、修订、定稿并达成一致意见。每项声明都被赋予了证据水平和推荐等级。
共制定了9项共识建议。亚肺叶切除术中节段间平面的识别、肺结节定位、肺肿瘤的淋巴绘图以及胃代食管灌注评估是目前有最充分证据支持的荧光成像应用。
基于现有最佳证据和专家意见，这些共识建议可能有助于在胸外科和食管外科手术中使用荧光成像。
