Evaluation of lymph flow patterns in splenic flexural colon cancers using laparoscopic real-time indocyanine green fluorescence imaging

Watanabe, Jun; Ota, Mitsuyoshi; Suwa, Yusuke; Ishibe, Atsushi; Masui, Hidenobu; Nagahori, Kaoru

doi:10.1007/s00384-016-2669-4

Cited by 131 publications

(136 citation statements)

References 32 publications

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“…The mean age of the patients was 66 years which is the typical age group affected by CRC . Most of the studies included tumors of different anatomic locations except three studies; two of them involved patients with rectal carcinoma and one involved patients with splenic flexure carcinoma. Approximately 60% of the patients had an early stage CRC (TNM I‐II).…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the SLN mapping, ICG NIR flouresence proved to be useful in evaluation of lymph flow patterns in patients with splenic flexure carcinoma. Watanabe et al applied real time ICG flouresence in 31 patients with splenic flexure tumors and reported that none of the patients exhibited lymph flow to the left colic artery and the left branch of the middle colic artery, concluding that ligation of both arteries is not mandatory. Moreover, none of the patients showed lymph flow directed to the pancreatic tail or the splenic hilum, therefore, the authors stated that routine distal pancreatectomy and splenectomy may not be necessary, at least in absence of widespread LN spread.…”

Section: Discussionmentioning

confidence: 99%

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Sensitivity and specificity of indocyanine green near‐infrared fluorescence imaging in detection of metastatic lymph nodes in colorectal cancer: Systematic review and meta‐analysis

Emile

Elfeki

Shalaby

et al. 2017

Journal of Surgical Oncology

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This review aimed to determine the overall sensitivity and specificity of indocyanine green (ICG) near-infrared (NIR) fluorescence in sentinel lymph node (SLN) detection in Colorectal cancer (CRC). A systematic search in electronic databases was conducted. Twelve studies including 248 patients were reviewed. The median sensitivity, specificity, and accuracy rates were 73.7, 100, and 75.7. The pooled sensitivity and specificity rates were 71% and 84.6%. In conclusion, ICG-NIR fluorescence is a promising technique for detecting SLNs in CRC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sensitivity and specificity of indocyanine green near‐infrared fluorescence imaging in detection of metastatic lymph nodes in colorectal cancer: Systematic review and meta‐analysis

Emile

Elfeki

Shalaby

et al. 2017

Journal of Surgical Oncology

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“…Watanabe et al . recently reported that lymphatic flow existed along the inferior mesenteric vein (IMV), in addition to along the left colic artery and middle colic artery, in splenic flexure cancer . Therefore, to perform optimal surgery for splenic flexure cancer, it would be useful to know the pattern of venous drainage preoperatively.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the venous drainage pattern of the splenic flexure by preoperative three‐dimensional computed tomography

Arimoto

Matsuda

Hasegawa

et al. 2018

Asian J Endoscop Surgery

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Introduction Anatomical evaluation of the splenic flexure vein is essential for complete mesocolic excision with central vascular ligation when treating patients with splenic flexure cancer. Although there have been several studies relating to the arterial branches of the splenic flexure, very limited data are available regarding the variation in venous anatomy in this region. Methods Sixty‐six patients with colorectal cancer who underwent preoperative 3‐D CT between April 2016 and April 2017 were included in this retrospective study. The pattern of the venous drainage of the splenic flexure and its association with the inferior border of the pancreas were evaluated. Results The inferior mesenteric vein flowed into the splenic vein in 32 patients (48.5%), into the superior mesenteric vein in 27 patients (40.9%), and into the confluence of splenic vein and superior mesenteric vein in 7 patients (10.6%). The splenic flexure vein joined the inferior mesenteric vein in 62 patients (93.9%), the splenic vein in 2 patients (3.0%), and the middle colic vein in 2 patients (3.0%). The splenic flexure vein flowed into the inferior mesenteric vein below the level of the inferior border of the pancreas in 58 patients (90.6%) and above it in 4 patients (6.3%). Conclusion Preoperative evaluation of the venous pattern of the splenic flexure on 3‐D CT is useful before complete mesocolic excision with central vascular ligation to avoid intraoperative bleeding during splenic flexure cancer surgery.

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“…Nishigori et al [28] found that ICG administered colonoscopically led to modification in the extent of mesenteric resection in nearly one quarter of patients and resulted in change of the colonic resection plan in nearly 17%. Watanabe et al [38] applied colonoscopically administered NIR ICG SLNM in 31 patients with splenic flexure cancers. They reported that none of these patients exhibited lymphatic flow to both the left colic artery and left branch of the middle colic artery concluding that routine ligation of both arteries is not required and that a tailored resection according to patient-specific drainage patterns could be appropriate.…”

Section: Resultsmentioning

confidence: 99%

Intraoperative Sentinel Node Mapping in the Colon: Potential and Pitfalls

Currie¹

2019

Eur Surg Res

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Sentinel lymph node mapping (SLNM) may play a significant role in future delivery of colon cancer surgery because of an increase in early-stage, node-negative disease due to national bowel cancer screening programmes. Traditionally, colon lymphatic drainage has not been thought relevant as the operative approach cannot be tailored. Recent advances in local and endoscopic risk-reducing interventions for colonic malignancy have caused a rethink in approach. SLNM was initially attempted with blue dye techniques with limited success. Technological improvement has allowed surgeons to use near-infrared (NIR) light and NIR active tracers such as indocyanine green. This review provides an overview of the current status of intraoperative lymph node mapping in the colon, identifies challenges to the delivery of the techniques, and discusses potential solutions that may help SLNM play a role in improving the delivery of surgical care for patients with colon cancer.

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Evaluation of lymph flow patterns in splenic flexural colon cancers using laparoscopic real-time indocyanine green fluorescence imaging

Abstract: The findings of the lymph flow pattern of splenic flexure suggest that lymph node dissection at the root of the IMV area is important, and it may be not necessary to ligate both the lt-MCA and LCA, at least in cases without widespread lymph node metastases.

Cited by 131 publications

References 32 publications

Sensitivity and specificity of indocyanine green near‐infrared fluorescence imaging in detection of metastatic lymph nodes in colorectal cancer: Systematic review and meta‐analysis

Sensitivity and specificity of indocyanine green near‐infrared fluorescence imaging in detection of metastatic lymph nodes in colorectal cancer: Systematic review and meta‐analysis

Evaluation of the venous drainage pattern of the splenic flexure by preoperative three‐dimensional computed tomography

Intraoperative Sentinel Node Mapping in the Colon: Potential and Pitfalls

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