One third of VTE events occurred after discharge. Postoperative VTE incidence was correlated with increasing Caprini scores. Patients in the high risk group had an incidence of 10.3%. Elevated scores may warrant extended chemoprophylaxis for patients after discharge.

Objective To investigate safety and feasibility of navigational bronchoscopy (NB)-guided near-infrared (NIR) localization of small, ill-defined lung lesions and sentinel lymph nodes (SLN) for accurate staging in non-small cell lung cancer (NSCLC) patients. Methods Patients with known or suspected stage I NSCLC were enrolled in a prospective pilot trial for lesion localization and SLN mapping via NB-guided NIR marking. Successful localization, SLN detection rates, histopathologic status of SLN vs overall nodes, and concordance to initial clinical stage were measured. Ex vivo confirmation of NIR+ SLNs and adverse events were recorded. Results Twelve patients underwent NB-guided marking with indocyanine green (ICG) of lung lesions ranging in size from 0.4 to 2.2 cm and located 0.1 to 3 cm from the pleural surface. An NIR+ “tattoo” was identified in all cases. Ten patients were diagnosed with NSCLC and 9 SLNs were identified in 8 of the 10 patients, resulting in an 80% SLN detection rate. SLN pathologic status was 100% sensitive and specific for overall nodal status with no false negative results. Despite prior nodal sampling, one patient was found to have metastatic disease in the SLN alone, a 12.5% rate of disease upstaging with NIR SLN mapping. SLN were detectable for up to 3 hours allowing time for obtaining a tissue diagnosis and surgical resection. There were no adverse events associated with NB-labeling or ICG dye itself. Conclusions NB-guided NIR lesion localization and SLN identification was safe and feasible. This minimally invasive image-guided technique may permit the accurate localization and nodal staging of early stage lung cancers.

Objective To assess safety and feasibility of an intraoperative, minimally invasive NIR image-guided approach to lymphatic mapping in esophageal cancer patients. Although local lymph nodes (LNs) are removed with the esophageal specimen, no techniques are available to identify the regional LNs (separate from the esophagus) during esophagectomy. We hypothesize that NIR imaging can identify regional LNs with potential to improve staging and the extent of lymphadenectomy (LAD). Methods Of the 10 patients enrolled, nine had resectable esophageal adenocarcinoma and underwent NIR mapping following peritumoral, submucosal injection of Indocyanine Green (ICG) alone or pre-mixed in human serum albumin (ICG:HSA) prior to resection. NIR imaging was performed in situ and ex vivo. Results Intraoperative NIR imaging demonstrated NIR signal at all tumors and in 2–6 NIR+ regional LNs in six of the patients. NIR+ LNs were not identified in 4 cases: one occult stage IV patient, for which further imaging was not performed and was thus excluded from analysis, and 3 cases in which ICG was used without HSA. Identification of local LNs on the esophagus was obscured by peritumoral background. Importantly, pathologic status of NIR+ regional LNs reflected overall regional nodal status. Conclusions NIR lymphatic mapping is safe and feasible in esophageal cancer and can identify regional LNs when ICG:HSA is used. Although future work is needed to improve background signal and local LN identification, intraoperative detection of regional NIR+ LNs allows in-depth histologic analysis of LN basins not commonly scrutinized as part of the specimen and may improve detection of occult nodal disease.

This study demonstrates a trend toward decreased symptomatic VTE after Caprini RAM implementation, as demonstrated among high-risk cancer patients. The absence of bleeding complications and high provider and patient adherence to VTE RAM support the safety and feasibility of a VTE prevention protocol in thoracic surgery patients.

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