Safety and efficacy of indocyanine green near-infrared fluorescent imaging-guided lymph nodes dissection during radical gastrectomy for gastric cancer: A systematic review and meta-analysis

Deng, Chun; Zhang, Zhenyu; Qi, Hengduo; Guo, Zhi; Liu, Yang; Xiao, Haimin; Li, Xiaojun

doi:10.3389/fonc.2022.917541

Cited by 12 publications

(5 citation statements)

References 53 publications

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“…Apart from the included literature, some indications were not reported because of the lack of quantitative assessment. For example, a large body of literature suggests the possibility of ICG-guided lymphadenectomy during gastrectomy [66,67]. The study by Okubo et al [68] indicates a difference in the intensity-to-background ratio between sentinel lymph nodes and non-sentinel lymph nodes in early gastric cancer and recommended intraoperative, quantitative measurement in future studies.…”

Section: Discussionmentioning

confidence: 99%

Quantification of Indocyanine Green Fluorescence Imaging in General, Visceral and Transplant Surgery

Pollmann

Juratli

Roushansarai

et al. 2023

JCM

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Near-infrared (NIR) imaging with indocyanine green (ICG) has proven to be useful in general, visceral, and transplant surgery. However, most studies have performed only qualitative assessments. Therefore, a systematic overview of all studies performing quantitative indocyanine green evaluation in general, visceral, and transplant surgeries should be conducted. Free term and medical subject heading (MeSH) term searches were performed in the Medline and Cochrane databases until October 2022. The main categories of ICG quantification were esophageal surgery (24.6%), reconstructive surgery (24.6%), and colorectal surgery (21.3%). Concordantly, anastomotic leak (41%) was the main endpoint, followed by the assessment of flap perfusion (23%) and the identification of structures and organs (14.8%). Most studies examined open surgery (67.6%) or laparoscopic surgery (23.1%). The analysis was mainly carried out using manufacturer software (44.3%) and open-source software (15.6%). The most frequently analyzed parameter was intensity over time for blood flow assessment, followed by intensity alone or intensity-to-background ratios for structure and organ identification. Intraoperative ICG quantification could become more important with the increasing impact of robotic surgery and machine learning algorithms for image and video analysis.

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Section: Discussionmentioning

confidence: 99%

Quantification of Indocyanine Green Fluorescence Imaging in General, Visceral and Transplant Surgery

Pollmann

Juratli

Roushansarai

et al. 2023

JCM

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“…In a clinical setting, we anticipate preoperative MRI will help plan lymphadenectomy by clearly highlighting occurrences where draining (magnetic) LNs are located outside of conventional surgical fields—for example, if D1 lymphadenectomy is planned but magnetic LNs are found in D2 stations. In combination with intraoperative lymphatic mapping by fluorescent ICG, this approach can provide clear differentiation of the draining lymphatic structures, reduce intraoperative bleeding [ 7 ], and provide surgical guidance to enable less experienced surgeons perform more targeted lymphatic resections (i.e. SNNS), which potentially results in reduced patient morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…In these patients, a much more specific and targeted approach to staging LN metastases could be beneficial [ 4 – 6 ], thereby creating a role for an accurate means of SLN localization in gastric cancer prognosis and treatment. While SLNB concepts, such as the conservative ‘pick-up’ method of lymphadenectomy have been trialled in gastric cancer [ 4 ], given the complexity of lymphatic drainage in this region, improved prognostic outcomes are correlated with an increased number of removed LNs [ 4 , 7 , 8 ]. Here, a greater number of removed LNs increases the chance of capturing the high-risk SLNs likely to contain metastases.…”

mentioning

confidence: 99%

Preclinical evaluation of sentinel node localization in the stomach via mannose-labelled magnetic nanoparticles and indocyanine green

Cousins

Krishnan

et al. 2023

Surg Endosc

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Background Gastrectomy with extended (D2) lymphadenectomy is considered standard of care for gastric cancer to provide the best possible outcomes and pathologic staging. However, D2 gastrectomy is a technically demanding operation and reported to be associated with increased complications and mortality. Application of sentinel lymph node (SLN) concept in gastric cancer has the potential to reduce patient morbidity; however, SLN techniques are not established for gastrectomy, in part due to lack of practical tracers. An effective and convenient tracer with enhanced SLN accumulation is critically needed. Methods Mannose-labelled magnetic tracer ‘FerroTrace’ and fluorescent dye indocyanine green (ICG) were injected laparoscopically into the stomach submucosa of 8 healthy swine under general anaesthesia. Intraoperative fluorescence imaging was used to highlight draining lymphatic pathways containing ICG, while preoperative T2-weighted MRI and ex vivo magnetometer probe measurements were used to identify nodes containing FerroTrace. Lymphadenectomy was performed either robotically (n = 2) or via laparotomy (n = 6). Results Mixing ICG and FerroTrace ensured concurrence of fluorescent and magnetic signals in SLNs. An initial trial with robotic dissection removed all magnetic LNs (n = 4). In the subsequent laparotomy study that targeted all ICG-LNs based on intraoperative fluorescence imaging, dissection removed an average of 4.7 ± 1.2 fluorescent, and 2.0 ± 1.3 magnetic LNs per animal. Both MRI and magnetometer detected 100% of SLNs (n = 7). FerroTrace demonstrated high specificity to SLNs, which contained 76 ± 30% of total lymphotropic iron, and 88 ± 20 % of the overall magnetometer signal. Conclusions Through utilisation of this dual tracer approach, SLNs were identified via preoperative MRI, visualised intraoperatively with fluorescence imaging, and confirmed with a magnetometer. This combination pairs the sensitivity of ICG with SLN-specific FerroTrace and can be used for reliable SLN detection in gastric cancer, with potential applications in neoadjuvant therapy. Graphical abstract

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“…Several meta-analyses have reviewed the safety of ICG and all determined there to be no significant risk to the injection of the compound [14,15]. One study even found that the use of ICG was associated with decreased intraoperative blood loss [16].…”

Section: Properties Of Icg and Description Of Intraoperative Usementioning

confidence: 99%

Developments in the Use of Indocyanine Green (ICG) Fluorescence in Colorectal Surgery

Khalafi,

Botero Fonnegra,

Reyes

et al. 2024

Preprint

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Indocyanine Green (ICG) has significantly advanced minimally invasive surgery. It is widely recognized for its ability to visualize blood vessel patency in real-time across various surgical specialties. While its primary use in colorectal surgery is to evaluate anastomoses for leaks, nu-merous other applications have been documented in the literature. In this review, we aim to explore both established and emerging applications of ICG fluorescence in colorectal surgery, with the goal of improving patient outcomes. This includes preoperative tumor marking and the detection of metastatic disease. Some applications, such as lymphatic mapping, require further research to determine their impact on clinical practices. Conversely, oth-ers, like the intraoperative localizations of ureters, necessitate additional procedures and are not yet widely accepted by the surgical community. However, the development of alternative com-pounds could offer better solutions. Future research should focus on areas like quantitative ICG and protocol standardization in prospective multicenter studies.

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Safety and efficacy of indocyanine green near-infrared fluorescent imaging-guided lymph nodes dissection during radical gastrectomy for gastric cancer: A systematic review and meta-analysis

Cited by 12 publications

References 53 publications

Quantification of Indocyanine Green Fluorescence Imaging in General, Visceral and Transplant Surgery

Quantification of Indocyanine Green Fluorescence Imaging in General, Visceral and Transplant Surgery

Preclinical evaluation of sentinel node localization in the stomach via mannose-labelled magnetic nanoparticles and indocyanine green

Developments in the Use of Indocyanine Green (ICG) Fluorescence in Colorectal Surgery

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