吲哚菁绿近红外荧光成像引导下的胃癌根治术中淋巴结清扫的安全性和有效性：一项系统评价和荟萃分析
Safety and efficacy of indocyanine green near-infrared fluorescent imaging-guided lymph nodes dissection during radical gastrectomy for gastric cancer: A systematic review and meta-analysis.
作者信息
Deng Chun, Zhang Zhenyu, Qi Hengduo, Guo Zhi, Liu Yang, Xiao Haimin, Li Xiaojun
机构信息
Department of Gastrointestinal Surgery, the Second People's Hospital of Yibin, Yibin City, China.
Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an City, China.
出版信息
Front Oncol. 2022 Aug 16;12:917541. doi: 10.3389/fonc.2022.917541. eCollection 2022.
BACKGROUND
Indocyanine green (ICG) fluorescence imaging has been a new surgical navigation technique for gastric cancer. However, its clinical value should still be evaluated further. In this meta-analysis, we investigated the safety and efficacy of ICG near-infrared fluorescent imaging-guided lymph nodes (LNs) dissection during radical gastrectomy.
METHODS
Studies comparing ICG fluorescence imaging with standard care in patients with gastric cancer were systematically searched from PubMed, Embase, Web of Science, and Cochrane Library through August 2021. The current meta-analysis was performed according to the preferred reporting items for systematic review and meta-analysis guidelines. A pooled analysis was performed for the available data regarding the number of LNs dissection, the number of metastatic LNs dissection, other operative outcomes, and postoperative complications. R software version 4.2.0 and Stata 16.0 software were used for the present meta-analysis.
RESULTS
This analysis included 12 studies with a total of 1365 gastric cancer patients (569 in the ICG group and 796 in the non-ICG group). The number of retrieved LNs in the ICG group was significantly higher (weighted mean difference [WMD]=7.67, 95% confidence intervals [CI]: 4.73 to 10.62, P<0.05) compared to the non-ICG group with moderate heterogeneity (P<0.001, I 70%). The number of metastatic LNs, operative time, and postoperative complications were all comparable and without significant heterogeneity. Additionally, ICG near-infrared fluorescent imaging was associated with reduced intraoperative blood loss (WMD=-10.28, 95% CI: -15.22 to -5.35, P<0.05) with low heterogeneity (P=0.07, I2 = 43%).
CONCLUSIONS
ICG near-infrared fluorescent imaging-guided lymphadenectomy was considered to be safe and effective in gastrectomy. ICG was used to increase the number of LNs harvested while reducing intraoperative blood loss without increasing operative time or postoperative complications.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021291863.
背景
吲哚菁绿（ICG）荧光成像已成为一种用于胃癌的新型手术导航技术。然而，其临床价值仍有待进一步评估。在这项荟萃分析中，我们研究了ICG近红外荧光成像引导下的根治性胃切除术中淋巴结清扫的安全性和有效性。
方法
通过检索PubMed、Embase、Web of Science和Cochrane图书馆，系统地查找了截至2021年8月比较ICG荧光成像与胃癌患者标准治疗的研究。当前的荟萃分析是根据系统评价和荟萃分析的首选报告项目指南进行的。对有关淋巴结清扫数量、转移淋巴结清扫数量、其他手术结果和术后并发症的可用数据进行了汇总分析。本荟萃分析使用了R软件4.2.0版和Stata 16.0软件。
结果
该分析纳入了12项研究，共1365例胃癌患者（ICG组569例，非ICG组796例）。与非ICG组相比，ICG组回收的淋巴结数量显著更高（加权平均差[WMD]=7.67，95%置信区间[CI]：4.73至10.62，P<0.05），具有中度异质性（P<0.001，I²=70%）。转移淋巴结数量、手术时间和术后并发症均具有可比性，且无显著异质性。此外，ICG近红外荧光成像与术中出血量减少相关（WMD=-10.28，95%CI：-15.22至-5.35，P<0.05），异质性较低（P=0.07，I²=43%）。
结论
ICG近红外荧光成像引导下的淋巴结切除术在胃切除术中被认为是安全有效的。ICG用于增加回收的淋巴结数量，同时减少术中出血量，而不增加手术时间或术后并发症。
系统评价注册
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