Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Fujian Province Minimally Invasive Medical Center, Fujian Medical University Union Hospital, Fuzhou, China.
Ann Surg. 2024 Jun 1;279(6):923-931. doi: 10.1097/SLA.0000000000006242. Epub 2024 Feb 20.
To assess the effectiveness of indocyanine green (ICG)-guided lymph node (LN) dissection during laparoscopic radical gastrectomy after neoadjuvant chemotherapy (NAC) in patients with locally advanced gastric cancer (LAGC).
Studies on ICG imaging use in patients with LAGC on NAC are rare.
Patients with gastric adenocarcinoma (clinical T2-4NanyM0) who received NAC were randomly assigned to receive ICG-guided laparoscopic radical gastrectomy or laparoscopic radical gastrectomy alone. Here, we reported the secondary endpoints including the quality of lymphadenectomy (total retrieved LNs and LN noncompliance) and surgical outcomes.
Overall, 240 patients were randomized. Of whom, 236 patients were included in the primary analysis (118 in the ICG group and 118 in the non-ICG group). In the ICG group, the mean number of LNs retrieved was significantly higher than in the non-ICG group within the D2 dissection (48.2 vs 38.3, P < 0.001). The ICG fluorescence guidance significantly decreased the LN noncompliance rates (33.9% vs 55.1%, P = 0.001). In 165 patients without baseline measurable LNs, ICG significantly increased the number of retrieved LNs and decreased the LN noncompliance rate ( P < 0.05). For 71 patients with baseline measurable LNs, the quality of lymphadenectomy significantly improved in those who had a complete response ( P < 0.05) but not in those who did not ( P > 0.05). Surgical outcomes were comparable between the groups ( P > 0.05).
ICG can effectively improve the quality of lymphadenectomy in patients with LAGC who underwent laparoscopic radical gastrectomy after NAC.
评估吲哚菁绿（ICG）引导下的淋巴结（LN）解剖在接受新辅助化疗（NAC）后的局部进展期胃癌（LAGC）患者腹腔镜根治性胃切除术中的有效性。
关于接受 NAC 的 LAGC 患者的 ICG 成像应用研究很少。
接受胃腺癌（临床 T2-4NanyM0）NAC 的患者被随机分配接受 ICG 引导下的腹腔镜根治性胃切除术或单独的腹腔镜根治性胃切除术。在这里，我们报告了包括淋巴结清扫质量（总检出淋巴结和淋巴结不合格）和手术结果在内的次要终点。
共有 240 名患者被随机分配。其中，236 名患者被纳入主要分析（ICG 组 118 例，非 ICG 组 118 例）。在 ICG 组中，D2 解剖中检出的淋巴结平均数量明显高于非 ICG 组（48.2 对 38.3，P < 0.001）。ICG 荧光引导显著降低了淋巴结不合格率（33.9%对 55.1%，P = 0.001）。在 165 名无基线可测量淋巴结的患者中，ICG 显著增加了检出的淋巴结数量，并降低了淋巴结不合格率（P < 0.05）。在 71 名有基线可测量淋巴结的患者中，完全缓解的患者淋巴结清扫质量显著改善（P < 0.05），而未缓解的患者则没有（P > 0.05）。两组手术结果无差异（P > 0.05）。
ICG 可有效提高接受 NAC 后的腹腔镜根治性胃切除术后 LAGC 患者的淋巴结清扫质量。
