Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France.
Surg Endosc. 2023 Jul;37(7):5472-5481. doi: 10.1007/s00464-023-10043-8. Epub 2023 Apr 12.
The identification of metastatic lymph nodes is one of the most important prognostic factors in gastrointestinal (GI) cancers. Near-infrared fluorescence (NIRF) imaging has been successfully used in GI tumors to detect the lymphatic pathway and the sentinel lymph node (SLN), facilitating fluorescence image-guided surgery (FIGS) with the purpose to achieve a correct nodal staging. The aim of this study was to analyze the current results of NIRF SLN navigation and lymphography through data collected in the EURO-FIGS registry.
Prospectively collected data regarding patients and ICG-guided lymphadenectomies were analyzed. Additional analyses were performed to identify predictors of metastatic SLN and determinants of fluorescence positivity and nodal metastases outside the boundaries of standard lymphadenectomies.
Overall, 188 patients were included by 18 surgeons from 10 different centers. Colorectal cancer was the most reported pathology (77.7%), followed by gastric (19.1%) and esophageal tumors (3.2%). ICG was injected with higher doses (p < 0.001) via extraparietal side (63.3%), and with higher volumes (p < 0.001) via endoluminal side (36.7%). Overall, NIRF SLN navigation was positive in 75.5% of all cases and 95.5% of positive SLNs were retrieved, with a metastatic rate of 14.7%. NIRF identification of lymph nodes outside standard lymphatic stations occurred in 52.1% of all cases, 43.8% of which were positive for metastatic involvement. Positive NIRF SLN identification was an independent predictor of metastasis outside standard lymphatic stations (OR = 4.392, p = 0.029), while BMI independently predicted metastasis in retrieved SLNs (OR = 1.187, p = 0.013). Lower doses of ICG were protective against NIRF identification outside standard of care lymphadenectomy (OR = 0.596, p = 0.006), while higher volumes of ICG were predictive of metastatic involvement outside standard of care lymphadenectomy (OR = 1.597, p = 0.001).
SLN mapping helps identifying potentially metastatic lymph nodes outside the boundaries of standard lymphadenectomies. The EURO-FIGS registry is a valuable tool to share and analyze European surgeons' practices.
在胃肠道（GI）癌症中，转移性淋巴结的识别是最重要的预后因素之一。近红外荧光（NIRF）成像已成功用于 GI 肿瘤，以检测淋巴管和前哨淋巴结（SLN），促进荧光图像引导手术（FIGS），以实现正确的淋巴结分期。本研究旨在通过 EURO-FIGS 登记处收集的数据来分析 NIRF SLN 导航和淋巴造影的当前结果。
前瞻性收集了有关患者和 ICG 引导的淋巴结切除术的数据。进行了额外的分析，以确定转移性 SLN 的预测因素以及荧光阳性和标准淋巴结清扫术以外的淋巴结转移的决定因素。
总体而言，18 名外科医生来自 10 个不同的中心，共纳入了 188 名患者。报告的病理最常见的是结直肠癌（77.7%），其次是胃癌（19.1%）和食管癌（3.2%）。ICG 通过更高的剂量（p<0.001）经壁外途径（63.3%）和更高的体积（p<0.001）经腔内途径（36.7%）注射。总体而言，NIRF SLN 导航在所有病例中的阳性率为 75.5%，95.5%的阳性 SLN 被检出，转移率为 14.7%。在所有病例中，NIRF 识别标准淋巴结站以外的淋巴结发生率为 52.1%，其中 43.8%的淋巴结有转移受累。NIRF 识别阳性 SLN 是标准淋巴结清扫术以外淋巴结转移的独立预测因素（OR=4.392，p=0.029），而 BMI 独立预测了检出 SLN 的转移（OR=1.187，p=0.013）。较低剂量的 ICG 可防止 NIRF 识别标准护理淋巴结清扫术以外的淋巴结（OR=0.596，p=0.006），而较高体积的 ICG 可预测标准护理淋巴结清扫术以外的转移性受累（OR=1.597，p=0.001）。
SLN 绘图有助于识别标准淋巴结清扫术以外潜在的转移性淋巴结。EURO-FIGS 登记处是分享和分析欧洲外科医生实践的有价值工具。
