J Gastric Cancer.  2018 Jun;18(2):161-171. 10.5230/jgc.2018.18.e19.

Assessment of the Completeness of Lymph Node Dissection Using Near-infrared Imaging with Indocyanine Green in Laparoscopic Gastrectomy for Gastric Cancer

• Kim TH
• Kong SH
• Park JH
• Son YG
• Huh YJ
• Suh YS
• Lee HJ
• Yang HK

• KMID: 2414536
• DOI: http://doi.org/10.5230/jgc.2018.18.e19

Abstract

PURPOSE
This study assessed the feasibility of near-infrared (NIR) imaging with indocyanine green (ICG) in investigating the completeness of laparoscopic lymph node (LN) dissection for gastric cancer.
MATERIALS AND METHODS
Patients scheduled for laparoscopic gastrectomy for treating gastric cancer were enrolled in the study. After intraoperative submucosal ICG injection (0.05 mg/mL), LN dissection was performed under conventional laparoscopic light. After dissection, the LN stations of interest were examined under the NIR mode to locate any extra ICG-stained (E) tissues, which were excised and sent for pathologic confirmation. This technique was tested in 2 steps: infra-pyloric LN dissection (step 1) and review of all stations after proper radical node dissection (step 2).
RESULTS
In step 1, 15 patients who underwent laparoscopic pylorus-preserving gastrectomy (LPPG) and 15 patients who underwent laparoscopic distal gastrectomy (LDG) were examined. Seven and 2 E-tissues were obtained during LPPG and LDG, respectively. From the retrieved E-tissues, 1 and 0 tissue obtained during LPPG and LDG, respectively, was confirmed as LN. In step 2, 20 patients were enrolled (13 D1+ dissection and 7 D2 dissection). Six E-tissues were retrieved from 5 patients, and 1 tissue was confirmed as LN in the pathologic review. Overall, 15 E-tissues were detected and removed, and 2 tissues were confirmed as LNs in the pathologic review. Both nodes were from LN station #6, with 1 case each in the LDG and LPPG groups.
CONCLUSIONS
NIR imaging may provide additional node detection during laparoscopic LN dissection for gastric cancer, especially in the infra-pyloric area.

Keyword

Indocyanine green; NIR; Diagnostic imaging; Lymph nodes; Gastric cancer

MeSH Terms

Diagnostic Imaging
Gastrectomy*
Humans
Indocyanine Green*
Lymph Node Excision*
Lymph Nodes*
Stomach Neoplasms*
Indocyanine Green

Figure

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  Fig. 1 View of the infra-pyloric area 5 minutes after endoscopic submucosal injection of (4 sites of the antrum): (A) under white light and (B) in NIR mode. ICG = indocyanine green; NIR = near-infrared.

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  Fig. 2 Bidirectional dispersion of fluorescence after endoscopic submucosal injection of ICG on the anterior wall of the stomach: (A) under white light and (B) in NIR mode. ICG = indocyanine green; NIR = near-infrared.

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  Fig. 3 Comparison of additional tissue dissection guided with a NIR camera. Before dissection of the near infra-artery in a case of LPPG: (A) under white light view and (B) in NIR mode. After dissection: (C) under white light view and (D) confirmation with the NIR mode. After dissection, tissue with additional ICG uptake (E-tissue) in the left gastric artery in LDG: (E) under white light and (F) in NIR mode. After additional dissection of the E-tissue (G) under white light and (H) in NIR mode. NIR = near-infrared; LPPG = laparoscopic pylorus-preserving gastrectomy; ICG = indocyanine green; LDG = laparoscopic distal gastrectomy.

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