Calì Matteo, Aiolfi Alberto, Sato Sho, Hwang Jawon, Bonitta Gianluca, Albanesi Francesca, Bonavina Giulia, Cavalli Marta, Campanelli Giampiero, Biondi Antonio, Bonavina Luigi, Bona Davide
I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20122 Milan, Italy.
Department of Surgery, Minimally Invasive UGI Surgery and Oncology, Yokohama City University Gastroenterological Center, Yokohama 232-0024, Japan.
Cancers (Basel). 2025 Mar 14;17(6):980. doi: 10.3390/cancers17060980.
Indocyanine green-guided (ICG-guided) lymphadenectomy during gastrectomy for cancer has been proposed to enhance the accuracy of lymphadenectomy. The impact of ICG-guided lymphadenectomy on patient survival remains debated.
The findings of the systematic review were reconstructed into an individual patient data (IDP) meta-analysis with restricted mean survival time difference (RMSTD). Overall survival (OS) and disease-free (DFS) survival were primary outcomes. RMSTD, standardized mead difference (SMD), and 95% confidence intervals (CI) were used as pooled effect size measures.
Three studies (6325 patients) were included; 42% of patients underwent ICG-guided lymphadenectomy. The patients' age ranged from 47 to 72 years and 58% were males. Proximal, distal, and total gastrectomy were completed in 6.8%, 80.4%, and 12.8% of patients, respectively. The surgical approach was laparoscopic (62.3%) and robotic (37.7%). ICG-guided lymphadenectomy was associated with a higher number of harvested lymph nodes compared to non-ICG-guided lymphadenectomy (SMD 0.50; 95% CI 0.45-0.55). At the 42-month follow-up, OS and DFS estimates for ICG-guided vs. non-ICG-guided lymphadenectomy were 0.5 months (95% CI -0.01, 1.1) and 1.3 months (95% CI 0.39, 2.15), respectively.
Our analysis suggests that ICG-guided lymphadenectomy offers equivalent long-term OS and DFS compared to non-ICG-guided lymphadenectomy.
有人提出在胃癌胃切除术中采用吲哚菁绿引导（ICG引导）的淋巴结清扫术可提高淋巴结清扫的准确性。ICG引导的淋巴结清扫术对患者生存的影响仍存在争议。
将系统评价的结果重构为具有受限平均生存时间差（RMSTD）的个体患者数据（IDP）荟萃分析。总生存期（OS）和无病生存期（DFS）为主要结局。RMSTD、标准化均数差（SMD）和95%置信区间（CI）用作合并效应量指标。
纳入三项研究（6325例患者）；42%的患者接受了ICG引导的淋巴结清扫术。患者年龄在47至72岁之间，58%为男性。分别有6.8%、80.4%和12.8%的患者完成了近端、远端和全胃切除术。手术方式为腹腔镜手术（62.3%）和机器人手术（37.7%）。与非ICG引导的淋巴结清扫术相比，ICG引导的淋巴结清扫术切除的淋巴结数量更多（SMD 0.50；95%CI 0.45 - 0.55）。在42个月的随访中，ICG引导与非ICG引导的淋巴结清扫术的OS估计值分别为0.5个月（95%CI -0.01，1.1）和1.3个月（95%CI 0.39，2.15）。
我们的分析表明，与非ICG引导的淋巴结清扫术相比，ICG引导的淋巴结清扫术具有相当的长期OS和DFS。
