Sentinel node mapping guided by indocyanine green fluorescence imaging during laparoscopic surgery in gastric cancer.
BACKGROUND
Indocyanine green (ICG) fluorescence imaging has recently been reported as a new method for sentinel node (SN) mapping in several types of cancers. In this study, we determined the possible usefulness of SN mapping guided by ICG fluorescence imaging during laparoscopy-assisted gastrectomy (LAG) for gastric cancer.


METHODS
Our series consisted of 77 patients with cT1- or cT2-stage gastric cancer who had undergone LAG (LAG group; 38 patients) or conventional open gastrectomy (OG group; 39 patients). Intraoperative SN mapping guided by ICG fluorescence imaging was conducted with a charge-coupled device camera with a light-emitting diode as the light source and a cut filter as the detector.


RESULTS
The detection rate and mean number of fluorescent nodes (FNs) were 94.7% and 7.9, respectively, in the LAG group, and 94.9% and 7.2, respectively, in the OG group. The accuracy and false-negative rates were 97.2% (35 of 36 cases) and 25% (1 of 4), respectively, in the LAG group, and 91.9% (34 of 37) and 23.1% (3 of 13), respectively, in the OG group. Among 33 LAG group patients and 27 OG group patients without FN metastasis, lymph node metastasis was found only in non-SNs located in the same lymphatic basin as the detected FNs.


CONCLUSIONS
SN mapping guidance by ICG fluorescence imaging could be useful for predicting the lymph node metastasis in gastric cancer, even during LAG. Our data suggest that dissection of the lymphatic basin containing FNs with laparoscopic surgery may be a promising approach as a new type of minimally invasive surgery for patients with cT1- or cT2-stage gastric cancer having no metastasis in FNs.
Tajima
Yusuke
Y
Department of Surgery, Showa University, Tokyo, Japan. surgery@med.showa-u.ac.jp
Murakami
Masahiko
M
Yamazaki
Kimiyasu
K
Masuda
Yuki
Y
Kato
Masanori
M
Sato
Atsushi
A
Goto
Satoru
S
Otsuka
Koji
K
Kato
Takashi
T
Kusano
Mitsuo
M
D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D003952:Diagnostic Imaging; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007208:Indocyanine Green; D010535:Laparoscopy; D008207:Lymphatic Metastasis; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000601:surgery*
D004396:Coloring Agents; D007208:Indocyanine Green