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.
Highlights
Gastric cancer is the fifth most frequently diagnosed cancer and the fourth leading cause of death from cancer worldwide [1]
No significant differences were observed in sex, age, body mass index (BMI), American Society of Anesthesiology (ASA) score, or ECOG performance status between the two groups (P > 0.05), which indicates that the baseline characteristics of the two groups were comparable. (Table 1)
The data were compared between the two groups, and no significant differences were observed in terms of first flatus (63.50 ± 27.345 vs 68.26 ± 28.83, P>0.05), first water intake (85.51 ± 29.03 vs 92.43 ± 28.48, P>0.05), or postoperative hospital stay (9.22 ± 2.48 vs 9.26 ± 3.04, P>0.05)
Summary
Gastric cancer is the fifth most frequently diagnosed cancer and the fourth leading cause of death from cancer worldwide [1]. Composing complete removal of the tumor and systemic lymph node (LN) dissection, radical surgery remains the mainstay frontline treatment for resectable gastric cancer [2–4]. Adequate assessment of the lymph nodes is essential for its role in the disease stage and its prognostic value [5–10], and D2 lymphadenectomy is recommended for advanced gastric cancer [2–4, 11–13]. Laparoscopic gastrectomy (LG) was first reported by Kitano [14] in 1994 and applied in the treatment of advanced gastric cancer by Goh [15] in 1997. Because of the lack of tactile feedback and direct observation compared with open surgery, precise tumor positioning under laparoscopy is relatively difficult, especially for patients with early gastric cancer not invading the serosa and those who need additional surgery after noncurative ESD. This study aimed to observe the application and evaluate the feasibility and safety of indocyanine green (ICG) fluorescence technology in laparoscopic radical gastrectomy (LRG)
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