Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan.
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Tech Coloproctol. 2023 Sep;27(9):759-767. doi: 10.1007/s10151-023-02761-x. Epub 2023 Feb 11.
We previously reported that indocyanine green fluorescence imaging (ICG-FI)-guided laparoscopic lateral pelvic lymph node dissection (LPLND) was able to increase the total number of harvested lateral pelvic lymph nodes without impairing functional preservation. However, the long-term outcomes of ICG-FI-guided laparoscopic LPLND have not been evaluated. The aim of the present study was to compare the long-term outcomes of ICG-FI-guided laparoscopic LPLND to conventional laparoscopic LPLND without ICG-FI.
This was a retrospective, multi-institutional study with propensity score matching. The study population included consecutive patients with middle-low rectal cancer (clinical stage II to III) who underwent laparoscopic LPLND between January 2013 and February 2018. The main evaluation items in this study were the 3-year overall survival, relapse-free survival (RFS), local recurrence rate, and lateral local recurrence (LLR) rate.
A total of 172 patients with middle-lower rectal cancer who had undergone laparoscopic LPLND were included in this study. After propensity score matching, 58 patients were matched in each of the ICG-FI and non-ICG-FI groups. There were no substantial differences in the baseline characteristics between the two groups. The ICG-FI group and non-ICG-FI group included 40 and 38 women and had a median age of 65 (IQR 60-72) and 66 (IQR 60-73) years, respectively. The median follow-up for all patients was 63.7 (IQR 51.3-76.8) months. The estimated respective 3-year overall survival, RFS, and local recurrence rates were 93.1%, 70.7%, and 5.2% in the ICG-FI group and 85.9%, 71.7%, and 12.8% in the non-ICG-FI group (p = 0.201, 0.653, 0.391). The 3-year cumulative LLR rate was 0% in the ICG-FI group and 9.3% in the non-ICG-FI group (p = 0.048).
This study revealed that laparoscopic LPLND combined with ICG-FI was able to decrease the LLR rate. It appears that ICG-FI could contribute to improving the quality of laparoscopic LPLND and strengthening local control of the lateral pelvis.
This study was registered with the Japanese Clinical Trials Registry as UMIN000041372 ( http://www.umin.ac.jp/ctr/index.htm ).
我们之前报道过，吲哚菁绿荧光成像（ICG-FI）引导下的腹腔镜侧盆腔淋巴结清扫术（LPLND）能够增加侧盆腔淋巴结的总清扫数量，而不会损害功能保留。然而，ICG-FI 引导下腹腔镜 LPLND 的长期结果尚未得到评估。本研究的目的是比较 ICG-FI 引导下腹腔镜 LPLND 与无 ICG-FI 的传统腹腔镜 LPLND 的长期结果。
这是一项回顾性、多机构研究，采用倾向评分匹配。研究人群包括 2013 年 1 月至 2018 年 2 月期间接受腹腔镜 LPLND 的中低位直肠癌（临床分期 II 至 III 期）连续患者。本研究的主要评价项目为 3 年总生存率、无复发生存率（RFS）、局部复发率和侧局部复发（LLR）率。
本研究共纳入 172 例接受腹腔镜 LPLND 的中低位直肠癌患者。经过倾向评分匹配后，每组 58 例患者匹配。两组患者的基线特征无明显差异。ICG-FI 组和非 ICG-FI 组分别有 40 名和 38 名女性，中位年龄分别为 65（IQR 60-72）和 66（IQR 60-73）岁。所有患者的中位随访时间为 63.7（IQR 51.3-76.8）个月。ICG-FI 组的 3 年总生存率、RFS 和局部复发率分别为 93.1%、70.7%和 5.2%，非 ICG-FI 组分别为 85.9%、71.7%和 12.8%（p=0.201，0.653，0.391）。ICG-FI 组 3 年累积 LLR 率为 0%，非 ICG-FI 组为 9.3%（p=0.048）。
本研究表明，腹腔镜 LPLND 联合 ICG-FI 可降低 LLR 率。ICG-FI 似乎可以提高腹腔镜 LPLND 的质量，并加强侧盆腔的局部控制。
本研究在日本临床试验注册中心注册，注册号为 UMIN000041372（http://www.umin.ac.jp/ctr/index.htm）。
