The Clinical Value of Fluorescent Lymphography with Indocyanine Green During Robotic Surgery for Gastric Cancer: a Matched Cohort Study

Cianchi, Fabio; Indennitate, Giampiero; Paoli, Beatrice; Ortolani, Manuela; Lami, G; Manetti, Natalia; Tarantino, Ottaviano; Messeri, Sara; Foppa, Caterina; Badii, Benedetta; Novelli, Luca; Skalamera, Ileana; Nelli, Tommaso; Coratti, Francesco; Perigli, Giuliano; Staderini, Fabio

doi:10.1007/s11605-019-04382-y

Cited by 52 publications

(36 citation statements)

References 29 publications

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“…Similar results for lymph node mapping during gastric cancer surgery have recently been reported by Cianci et al [ 12 ]. The described study aimed to investigate whether ICG fluorescence lymphography has the potential to improve intraoperative visualization of lymph nodes in a matched cohort study during robotic gastrectomy for gastric cancer.…”

Section: Lymph Node Mapping With Icg-fi In Gastric Carcinomasupporting

confidence: 88%

New Intraoperative Imaging Tools and Image-Guided Surgery in Gastric Cancer Surgery

et al. 2022

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Innovations and new advancements in intraoperative real-time imaging have gained significant importance in the field of gastric cancer surgery in the recent past. Currently, the most promising procedures include indocyanine green fluorescence imaging (ICG-FI) and hyperspectral imaging or multispectral imaging (HSI, MSI). ICG-FI is utilized in a broad range of clinical applications, e.g., assessment of perfusion or lymphatic drainage, and additional implementations are currently investigated. HSI is still in the experimental phase and its value and clinical relevance require further evaluation, but initial studies have shown a successful application in perfusion assessment, and prospects concerning non-invasive tissue and tumor classification are promising. The application of machine learning and artificial intelligence technologies might enable an automatic evaluation of the acquired image data in the future. Both methods facilitate the accurate visualization of tissue characteristics that are initially indistinguishable for the human eye. By aiding surgeons in optimizing the surgical procedure, image-guided surgery can contribute to the oncologic safety and reduction of complications in gastric cancer surgery and recent advances hold promise for the application of HSI in intraoperative tissue diagnostics.

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Section: Lymph Node Mapping With Icg-fi In Gastric Carcinomasupporting

confidence: 88%

New Intraoperative Imaging Tools and Image-Guided Surgery in Gastric Cancer Surgery

et al. 2022

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“…Tajima et al [ 28 ] found that intraoperative subserosal injection was less accurate than preoperative submucosal injection of ICG for detecting sentinel LNs. Moreover, some retrospective studies [ 29 , 30 ] support the use of submucosal injection of ICG for fluorescence-guided lymphadenectomy the day before surgery. These inconsistent results may be explained by the selection bias inherent in retrospective investigations and varying injection sites, time, and concentrations of ICG used across studies.…”

Section: Discussionmentioning

confidence: 99%

Comparison of submucosal and subserosal approaches toward optimized indocyanine green tracer-guided laparoscopic lymphadenectomy for patients with gastric cancer (FUGES-019): a randomized controlled trial

Chen

Zhong

et al. 2021

BMC Med

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Background Application of indocyanine green (ICG) fluorescence imaging is effective in guiding laparoscopic radical lymphadenectomy for gastric cancer. However, the optimal approach for indocyanine green injection is controversial. Therefore, the objective of this study was aimed to compare the efficacy and ICG injection between the preoperative submucosal and intraoperative subserosal approaches for lymph node (LN) tracing during laparoscopic gastrectomy. Method This randomized controlled trial (ClinicalTrials.gov, NCT04219332) included 266 patients with potentially resectable gastric cancer (cT1–T4a, N0/+, M0) enrolled from a tertiary teaching center between December 2019 and October 2020. The primary endpoint was total number of retrieved LNs. Results In total, 259 patients (n = 130 and n = 129 in the submucosal and subserosal groups, respectively) were included in the per-protocol analysis. There are no significant differences in total number of retrieved LNs between the two groups (49.8 vs. 49.2, P = 0.713). The rate of LN noncompliance in the submucosal group was comparable to that in the subserosal group (32.3% vs. 33.3%, P = 0.860). No significant difference was found between the submucosal and subserosal groups in terms of the incidence (17.7% vs. 16.3%; P = 0.762) or severity of postoperative complications. The mean fluorescence cost in the submucosal group was higher than that in the subserosal group ($335.3 vs. $182.4; P < 0.001). The overall treatment satisfaction score was lower in the submucosal group than in the subserosal group (70.5 vs. 76.1%, P = 0.048). Conclusion ICG administered by subserosal injection was comparable to that administered by submucosal injection for lymph node tracing in gastric cancer. However, the former approach imposed a lower economic and mental burden on patients undergoing laparoscopic D2 lymphadenectomy. Trial registration ClinicalTrials.gov, NCT04219332.

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“…Herrera-Almario et al (28) reported its application in oncological gastric resections providing real time intraoperative feedback regarding lymph node identification with a surgical time increase of less than 10 min. More recently, Cianchi et al (29) in a matched cohort study described additional node detection during robotic surgery for gastric cancer. Despite a higher number of total lymph nodes harvested in the ICG group, its results failed to show good selectivity for metastatic occurence.…”

Section: Discussionmentioning

confidence: 99%

Indocyanine Green Fluorescence Imaging in Robotic Surgery: State of Art, Tips and Tricks in Current Applications

Morrell

Morrell-Junior

et al. 2021

Arq. Gastroenterol.

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BACKGROUND: Fluorescent imaging with indocyanine green is an emerging technology whose benefits are put in perspective. OBJECTIVE: This article reports essential principles and approaches of intraoperative fluorescence in general surgery bringing familiarity to its practical usage. Our group describes possible pitfalls and provides tips and tricks for training surgeons making their attempts easier and reproducible during practice. METHODS: This study overviews the most structured concepts, practical applications and its tricks in robotic fluorescence guided imaging surgery with indocyanine green. Possible pitfalls are emphasized and emerging fields of application are put in a perspective. RESULTS: Guided information and practical applications in several surgical fields are described for a safe and reproducible indocyanine green fluorescence imaging use. CONCLUSION: Robotic assisted surgery combined to fluorescence imaging technology represents a logical evolution in image guided surgery and technology familiarity with guided information may represent a wider and safer spectrum of use in surgeons’ hands.

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The Clinical Value of Fluorescent Lymphography with Indocyanine Green During Robotic Surgery for Gastric Cancer: a Matched Cohort Study

Cited by 52 publications

References 29 publications

New Intraoperative Imaging Tools and Image-Guided Surgery in Gastric Cancer Surgery

New Intraoperative Imaging Tools and Image-Guided Surgery in Gastric Cancer Surgery

Comparison of submucosal and subserosal approaches toward optimized indocyanine green tracer-guided laparoscopic lymphadenectomy for patients with gastric cancer (FUGES-019): a randomized controlled trial

Indocyanine Green Fluorescence Imaging in Robotic Surgery: State of Art, Tips and Tricks in Current Applications

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