Kinoshita Hiromitsu, Kawada Kenji, Itatani Yoshiro, Okamura Ryosuke, Oshima Nobu, Okada Tomoaki, Hida Koya, Obama Kazutaka
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Surgery, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan.
Langenbecks Arch Surg. 2023 Jan 18;408(1):38. doi: 10.1007/s00423-023-02808-5.
Although numerous studies have highlighted the potential value of indocyanine green (ICG) imaging in lymph node dissection of cancer surgery, its efficacy and optimal method remain to be clarified. This study aimed to investigate how lymphatic flow observation via ICG fluorescence could contribute to colon cancer surgery.
From October 2018 to March 2021, a total of 56 patients with colon cancer who underwent laparoscopic complete mesocolic excision with intraoperative ICG imaging were analyzed. Lymphatic flow was examined at the following time points following ICG injection: within 5 min, 30-60 min, and over 60 min. We also evaluated the distribution of ICG fluorescence per each vascular pedicle.
Lymphatic flow was observed within 5 min following ICG injection in 6 cases (10.7%), and at 30-60 min following ICG injection in 43 cases (76.8%). ICG-stained vascular pedicles were variable especially in hepatic flexural, transverse, and splenic flexural colon cancer. Lymph node metastases were observed in 14 cases. Although metastatic lymph nodes were present only in the area along the ICG-stained vascular pedicles in 12 of the 14 cases, two patients exhibited lymph node metastasis in areas along the ICG-unstained vascular pedicles. ICG fluorescence was observed outside the standard range of lymph node dissection in 9 cases (20.9%: 9/43). Although addition of the proposed resection areas was made in 8 of these 9 cases, there was no pathologically positive lymph node.
Real-time ICG fluorescence imaging of lymph nodes may improve the performance of laparoscopic colon cancer surgery, although its oncological benefit is not yet clear.
尽管众多研究强调了吲哚菁绿（ICG）成像在癌症手术淋巴结清扫中的潜在价值，但其疗效和最佳方法仍有待明确。本研究旨在探讨通过ICG荧光观察淋巴流动对结肠癌手术有何帮助。
对2018年10月至2021年3月期间共56例行腹腔镜完整结肠系膜切除术并术中进行ICG成像的结肠癌患者进行分析。在注射ICG后的以下时间点检查淋巴流动：5分钟内、30 - 60分钟以及60分钟以上。我们还评估了每个血管蒂处ICG荧光的分布情况。
6例（10.7%）在注射ICG后5分钟内观察到淋巴流动，43例（76.8%）在注射ICG后30 - 60分钟观察到淋巴流动。ICG染色的血管蒂各不相同，尤其是在肝曲、横结肠和脾曲结肠癌中。观察到14例有淋巴结转移。虽然14例中的12例转移淋巴结仅存在于ICG染色血管蒂沿线区域，但有2例患者在ICG未染色血管蒂沿线区域出现淋巴结转移。9例（20.9%：9/43）在标准淋巴结清扫范围外观察到ICG荧光。尽管这9例中的8例增加了提议的切除区域，但没有病理阳性淋巴结。
淋巴结的实时ICG荧光成像可能会提高腹腔镜结肠癌手术的效果，尽管其肿瘤学益处尚不清楚。
