title: Identification of the Lymphatic Drainage Pattern of Esophageal Cancer with Near-Infrared Fluorescent Imaging.
abstract: OBJECTIVE
  Nodal status is one of the most important long-term prognostic factors for esophageal cancer. The aim of this study was to evaluate the ability of near-infrared (NIR) light fluorescent imaging to identify the lymphatic drainage pattern of esophageal cancer.
  
  
  METHODS
  Patients with distal esophageal cancer or esophagogastric junction cancer scheduled for esophagectomy were enrolled in this study. Before surgery, an endoscopy was performed with submucosal injection of 2 cc of indocyanine green (ICG) around the tumor. Real-time NIR images from the surgical field were obtained for each patient to visualize the lymphatic ICG drainage.
  
  
  RESULTS
  A total of nine patients were included in this study. Ivor Lewis esophagectomy was performed in all cases. ICG drainage was visualized to first drain along the left gastric nodes in eight patients (88.9%) and toward the diaphragmatic nodes in one patient (11.1%). The median number of resected nodes was 32. Three patients (33.3%) presented nodal involvement. All of them had positive nodes in the first nodal station identified with ICG.
  
  
  CONCLUSIONS
  Evaluation of the lymphatic drainage pattern with real-time NIR light fluorescent technique is feasible. Distal and esophagogastric junction tumors showed to drain first in the left gastric nodes in most of the cases.
authors.affiliation: 1 Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Francisco
authors.initials: F
authors.lastname: Schlottmann
authors.affiliation: 1 Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Arianna
authors.initials: A
authors.lastname: Barbetta
authors.affiliation: 2 Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mungo
authors.affiliation: 3 Department of Surgery, University of Wisconsin , Madison, Wisconsin.
authors.forename: Anne O
authors.initials: AO
authors.lastname: Lidor
authors.affiliation: 1 Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Daniela
authors.initials: D
authors.lastname: Molena
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D005240:Feasibility Studies; D005456:Fluorescent Dyes; D006801:Humans; D007208:Indocyanine Green; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging*; D061848:Optical Imaging / Q000379:methods*; D010865:Pilot Projects; D012189:Retrospective Studies; D019265:Spectroscopy, Near-Infrared
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green
keywords: esophageal cancer; lymphatic drainage; near-infrared imaging