Bozin Michael, Chew Shaun, Cabalag Carlos, Duong Cuong
Peter MacCallum Cancer Centre, Melbourne, Australia.
Ann Surg Oncol. 2025 Apr 9. doi: 10.1245/s10434-025-17235-7.
Indocyanine green (ICG), a near-infrared fluorescent dye, has the potential to improve oncological outcomes by increasing lymph node yield in oesophagogastric (OG) cancer. There is no consensus regarding the dose, timing, and method of injection. This study was designed to evaluate the variation in ICG administration and its potential impact on nodal yield in OG cancer surgery for the purpose of translation in Western patients.
A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The primary outcome of this review was nodal yield, and the secondary outcome was the diagnostic accuracy of ICG in detecting metastatic lymph nodes. A meta-analysis of diagnostic accuracy data was performed by using a random-effects model.
A total of 38 studies (12,138 patients) were included in the analysis. Nodal yield was significantly increased in the ICG groups by 7.6 nodes (95% confidence interval [CI] 5.9-9.4; P = 0.0001) compared with control. Trends towards greater nodal yield were observed when ICG was administered at doses less than 2.75 mg, on the day before surgery, and via subserosal injection, although these did not reach statistical significance. Of the 17 studies with diagnostic accuracy data, the pooled sensitivity and specificity of ICG were 0.81 (95% CI 0.67-0.90) and 0.41 (95% CI 0.29-0.53), I 90.5%.
Indocyanine green-assisted lymphadenectomy significantly increased lymph node yield, which may translate into improved survival in patients with OG cancer. The ICG dose, timing, and method of injection warrant standardisation to maximise its potential benefits in Western patients.
吲哚菁绿（ICG）是一种近红外荧光染料，有潜力通过提高食管胃癌（OG）手术的淋巴结清扫数量来改善肿瘤学预后。关于ICG的剂量、注射时间和方法尚无共识。本研究旨在评估ICG给药方式的差异及其对OG癌手术淋巴结清扫数量的潜在影响，以便在西方患者中进行转化应用。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统评价和Meta分析。本评价的主要结局是淋巴结清扫数量，次要结局是ICG检测转移性淋巴结的诊断准确性。采用随机效应模型对诊断准确性数据进行Meta分析。
分析共纳入38项研究（12,138例患者）。与对照组相比，ICG组的淋巴结清扫数量显著增加7.6枚（95%置信区间[CI]5.9 - 9.4；P = 0.0001）。当ICG剂量小于2.75 mg、在手术前一天给药以及通过浆膜下注射时，观察到淋巴结清扫数量有增加的趋势，尽管这些未达到统计学显著性。在17项有诊断准确性数据的研究中，ICG的合并敏感性和特异性分别为0.81（95%CI 0.67 - 0.90）和0.41（95%CI 0.29 - 0.53），I²为90.5%。
吲哚菁绿辅助淋巴结清扫显著增加了淋巴结清扫数量，这可能转化为OG癌患者生存率的提高。ICG的剂量、注射时间和方法需要标准化，以在西方患者中最大化其潜在益处。
