Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an City, China.
Department of Gastrointestinal Surgery, The Second People's Hospital of Yibin, Yibin City, China.
Minim Invasive Ther Allied Technol. 2023 Oct;32(5):240-248. doi: 10.1080/13645706.2023.2165415. Epub 2023 Jan 13.
In Asia, particularly, robotic gastrectomy has grown in popularity as a treatment for stomach cancer. Indocyanine green (ICG) and near-infrared (NIR) fluorescent imaging technology has been reported for robotic gastrectomy. However, the clinical value still should be further evaluated. In this meta-analysis, we investigated the safety and efficacy of ICG near-infrared fluorescent imaging-guided lymph node (LN) dissection during robotic gastrectomy.
Through July 2022, systematic searches of PubMed, Embase, Web of Science, and the Cochrane Library were conducted to find studies comparing ICG fluorescence imaging with conventional treatment in patients with gastric cancer. 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 lymph node dissections, other operative outcomes and postoperative complications. R studio software 4.2.2 was used for this meta-analysis.
This analysis includes five studies with a total of 312 gastric cancer patients (128 in the ICG group and 184 in the non-ICG group). In this meta-analysis, the number of retrieved LNs in the ICG group was significantly higher (weighted mean difference [WMD] = 8.80, 95% confidence intervals [CI]: 4.37-13.22, < 0.05) than that in the non-ICG group with moderate heterogeneity ( < 0.0001, I=53.3%). Intraoperative blood loss and postoperative complications were all comparable and without significant heterogeneity. Additionally, ICG near-infrared fluorescent imaging was associated with a reduced operative time (WMD= -11.85, 95% CI: -22.40 to -1.30, < 0.05) with low heterogeneity ( = 0.027, I= 2.1%).
ICG near-infrared fluorescent imaging-guided lymphadenectomy was considered to be safe and effective in robotic gastrectomy. ICG was used to increase the number of LNs harvested while reducing operative time without increasing intraoperative blood loss or postoperative complications.
在亚洲，机器人胃切除术作为一种治疗胃癌的方法越来越受欢迎。吲哚菁绿（ICG）和近红外（NIR）荧光成像技术已应用于机器人胃切除术。然而，其临床价值仍需进一步评估。在这项荟萃分析中，我们研究了吲哚菁绿近红外荧光成像引导下机器人胃切除术中淋巴结（LN）解剖的安全性和有效性。
截至 2022 年 7 月，通过系统检索 PubMed、Embase、Web of Science 和 Cochrane Library，查找比较胃癌患者接受 ICG 荧光成像与常规治疗的研究。本荟萃分析根据系统评价和荟萃分析首选报告项目进行。对可获得的关于淋巴结清扫数量、其他手术结果和术后并发症的数据进行了汇总分析。使用 R 工作室软件 4.2.2 进行了这项荟萃分析。
本分析纳入了五项研究，共 312 例胃癌患者（ICG 组 128 例，非 ICG 组 184 例）。荟萃分析结果显示，ICG 组的淋巴结检出数明显高于非 ICG 组（加权均数差 [WMD] = 8.80，95%置信区间 [CI]：4.37-13.22，<0.05），且存在中度异质性（<0.0001，I=53.3%）。术中出血量和术后并发症均相似，无显著异质性。此外，ICG 近红外荧光成像与手术时间缩短相关（WMD=-11.85，95%CI：-22.40 至-1.30，<0.05），且异质性较低（=0.027，I=2.1%）。
ICG 近红外荧光成像引导下的淋巴结清扫术在机器人胃切除术中被认为是安全有效的。ICG 可增加淋巴结检出数量，同时缩短手术时间，而不会增加术中出血量或术后并发症。
