Clinical Application of Indocyanine Green Fluorescence Technology in Laparoscopic Radical Gastrectomy

Abstract

BackgroundThis study aimed to observe the application and evaluate the feasibility and safety of indocyanine green (ICG) fluorescence technology in laparoscopic radical gastrectomy (LRG).MethodsPatients who underwent LRG & D2 lymphadenectomy at Qilu Hospital of Shandong University were included between January 2018 and August 2019. According to whether endoscopic injection of ICG was performed, patients were assigned to the ICG group (n=107) and the control group (n=88). The clinicopathologic features, retrieved lymph nodes, postoperative recovery, and follow-up data were compared between the two groups.ResultsBaseline characteristics are comparable. The ICG group had a significantly larger number of lymph nodes retrieved (49.55 ± 12.72 vs. 44.44 ± 10.20, P<0.05), shorter total operation time (min) (198.22 ± 13.14 vs. 202.50 ± 9.91, P<0.05), shorter dissection time (min) (90.90 ± 5.34 vs. 93.74 ± 5.35, P<0.05) and less blood loss (ml) (27.51 ± 12.83 vs. 32.02 ± 17.99, P<0.05). The median follow-up time was 29.0 months (range 1.5-43.8 months), and there was no significant difference between the ICG group and the control group in 2-year OS (87.8% vs. 82.9%, P>0.05) or DFS (86.0% vs. 80.7%, P>0.05).ConclusionsICG fluorescence technology in laparoscopic radical gastrectomy has advantages in LN dissection, operation time, and intraoperative blood loss. The 2-year OS and 2-year DFS rates between the two groups were comparable. In conclusion, ICG fluorescence technology is feasible and safe.

Efficacy of indocyanine green fluorescence imaging-guided lymphadenectomy in radical gastrectomy for gastric cancer: A systematic review and meta-analysis

“…14 studies ( 13 , 14 , 17 – 21 , 23 – 29 ) reported the operation time and the pooled analysis showed no difference between the ICG and control groups (MD = −9.38, 95% CI = −21.70 to 2.93, P = 0.14) ( Figure 5A ). However, 11 studies ( 13 , 16 – 21 , 23 , 26 – 28 ) reported the intraoperative blood loss and showed that the use of ICG could reduce intraoperative blood loss (MD = -17.96, 95% CI = -27.89 to -8.04, P = 0.0004) ( Figure 5B ). 12 studies ( 13 , 14 , 16 – 21 , 23 , 26 – 28 ) reported the overall complications and there was a trend that the use of ICG was related to less overall complications with no statistic difference (OR = 0.78, 95% CI = 0.57 to 1.05, P = 0.10) ( Figure 5C ).…”

“…A total of 612 studies were identified, and 17 studies including 15 retrospective studies and 2 randomized controlled trials (RCTs) were ultimately included in this meta-analysis (13,14,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The details of the selection procedures are shown to be in line with the PRISMA flowchart (Figure 1).…”

“…The primary outcome of this study was to assess the efficacy of lymphadenectomy by using ICG fluorescence imaging. Ultimately, 17 studies (2274 patients) (13,14,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) reporting this outcome were included in our meta-analysis. The pooled analysis revealed that the number of retrieved LNs in the ICG group was significantly more than that in the control group (MD = 7.41, 95% CI = 5.44 to 9.37, P < 0.00001) (Figure 4A), but there is no significant difference in terms of metastatic LNs between the ICG and control groups (MD = -0.05, 95% CI = -0.25 to 0.16, P = 0.65) (Figure 4B).…”

“…14 studies (13,14,(17)(18)(19)(20)(21)(23)(24)(25)(26)(27)(28)(29) reported the operation time and the pooled analysis showed no difference between the ICG and control groups (MD = −9.38, 95% CI = −21.70 to 2.93, P = 0.14) (Figure 5A). However, 11 studies (13, 16-21, 23, 26-28) reported the intraoperative blood loss and showed that the use of ICG could reduce intraoperative blood loss (MD = -17.96, 95% CI = -27.89 to -8.04, P = 0.0004) (Figure 5B).…”

Clinicopathological features and management strategy for superficial nonampullary duodenal tumors: a multi-center retrospective study

“…However, some institutions are not possible to use intraoperative endoscopy for LECS in the clinical setting. According to experiences for gastric tumors due to its rarity of duodenal reports, tattooing using dye or blood, preoperative endoscopic clipping (combining with intraoperative portable abdominal radiography, intraoperative laparoscopic ultrasonography or preoperative 3-dimensional CT reconstruction measurements), fluorescence imaging with indocyanine green could be challenging but alterative solutions [ 23 24 25 ]. Compared with these methods, LECS has advantages in easy detection of tumors and direct detection of postanastomotic complications, although it is required need of endoscopic instruments and endoscopists [ 24 ].…”