已入深夜,您辛苦了!由于当前在线用户较少,发布求助请尽量完整的填写文献信息,科研通机器人24小时在线,伴您度过漫漫科研夜!祝你早点完成任务,早点休息,好梦!

A safe and effective surgical navigation technique in laparoscopic radical gastrectomy: Indocyanine green‐mediated near‐infrared fluorescent imaging

吲哚青绿 医学 淋巴结切除术 腹腔镜检查 胃切除术 腹腔镜手术 根治性手术 癌症 淋巴系统 放射科 影像引导手术 外科 病理 内科学
作者
Yan Qian,Shirong Cai
出处
期刊:Cancer communications [Wiley]
卷期号:40 (6): 270-272 被引量:8
标识
DOI:10.1002/cac2.12033
摘要

In the past decades, gastric cancer (GC) is one of the most common cancers and causes of cancer-related deaths worldwide [1]. China has the highest incidence of GC [2] and accounts for more than 40% of all new GC cases in the world [3]. Radical lymphadenectomy serves as an important role in the staging and definitive management of GC [4, 5]. At present, laparoscopic radical gastrectomy has been shown to significantly improve the accuracy of tumor staging and long-term survival of GC patients [6]. The retrieval of more lymph nodes (LNs) via lymphadenectomy is a current requirement for laparoscopic radical gastrectomy [5]. Lymphadenectomy is usually performed according to the experience of surgeons. However, it is a substantial challenge for surgeons to efficiently and accurately acquire enough LNs without increasing the risk of complications as the vascular and lymphatic anatomy of stomach is extremely complex. Therefore, surgeons are looking for more accurate strategies to perform adequate lymphadenectomy under laparoscopic guidance. In recent years, surgical navigation techniques have proven to be effective in the localization of sentinel LNs in cancer patients [6]. One of the widely studied surgical navigation techniques in cancer surgery is indocyanine green (ICG)-mediated near-infrared (NIR) fluorescent imaging. It has already demonstrated promising results in the localization of LNs during surgery in many types of cancers [7, 8]. As ICG has better tissue penetration than other dyes and NIR imaging can more accurately identify LNs than visible light imaging [9, 10], ICG fluorescence imaging-guided laparoscopic radical gastrectomy has become a hot spot in GC treatment [11]. However, the findings regarding the actual benefits of using ICG for GC lymphadenectomy in previous studies is controversial [12, 13]. Additionally, almost all of these previous studies were retrospective studies with small sample size and were only focused on the evaluation of evaluated sentinel LNs and anastomotic blood flow [14, 15]. Therefore, it was necessary to conduct large-scale randomized clinical trials to evaluate the safety and effectiveness of ICG-guided LN dissection during laparoscopic radical gastrectomy in GC patients. In a study recently published in JAMA Surgery, titled "Safety and Efficacy of Indocyanine Green Tracer-Guided Lymph Node Dissection during Laparoscopic Radical Gastrectomy in Patients with Gastric Cancer: A Randomized Clinical Trial", Chen et al. [16] enrolled 258 resectable GC patients in a prospective randomized clinical trial to evaluate the safety and efficacy of ICG-mediated NIR fluorescent imaging during laparoscopic D2 lymphadenectomy. In this study, the patients were randomly assigned to ICG group (n = 129; underwent ICG-mediated NIR fluorescent imaging-guided laparoscopic gastrectomy) or non-ICG group (n = 129; underwent conventional laparoscopic gastrectomy). The mean number of positive LNs retrieved in the non-ICG group was significantly lower than that in the ICG group (42.0 vs. 50.5 LNs; P < 0.001). Similarly, within the scope of D2 lymphadenectomy, the mean total number of LNs retrieved in the non-ICG group was significantly lower than that in the ICG group (41.7 vs. 49.6 LNs; P < 0.001). In contrast, the LN noncompliance rate of the non-ICG group was significantly greater than that of the ICG group (57.4% vs. 31.8%; P < 0.001). Within 30 days after surgery, no significant difference was observed in the incidence of surgery-related complications between the ICG and non-ICG groups (15.5% vs. 16.3%; P = 0.86). These observations indicated that ICG-mediated NIR fluorescent imaging could noticeably improve the efficacy of lymphadenectomy during laparoscopic radical gastrectomy safely. Compared with previous studies, this clinical trial additionally enrolled a large number of GC patients with stage cT1-cT4a disease and the authors conducted an in-depth analysis using multiple parameters including the number of LNs retrieved within the scope of D2 lymphadenectomy, the total number of LNs retrieved, the LN noncompliance rate, the incidence of surgery-related complications. They could thereby accurately assess the safety and efficacy of ICG-mediated NIR fluorescent imaging-guided laparoscopic gastrectomy and showed its important role in guiding the choice of surgical navigation technology and accurate staging. Furthermore, since this prospective randomized clinical trial strictly followed the randomized clinical trial standards in patient selection, it avoided the selection bias and makes the general data comparable. Most importantly, it also developed the methods about the standard use of ICG. This clinical trial has several limitations. First, the data were only collected from a single center and the long-term follow-up data were not available. Second, only 56.3% of metastatic LNs were detected via fluorescence, indicating that there may be a great risk of false-negative results when ICG-mediated NIR fluorescent imaging is used to detect metastatic LNs. These false-negative results may have been owing to the infiltration of a large number of cancer cells in LNs or the obstruction of lymphatic vessels. Third, further analyses according to the tumor location were not performed; which may have led to uneven stratification of individual variables. Despite the limitations mentioned above, this prospective randomized clinical trial by Chen et al. showed more accuracy in evaluating the efficacy and perioperative safety of ICG-mediated NIR fluorescent imaging during laparoscopic D2 lymphadenectomy, compared to previous studies. The findings can promote the standardization of NIR imaging in laparoscopic resection of GC and lays the foundation for the application of ICG imaging in the radical resection of GC. The author read and approved the final manuscript. Not applicable. The author declares no competing interests. Not applicable. Not applicable. Not applicable. Not applicable.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
隐形曼青应助零零采纳,获得10
1秒前
3秒前
4秒前
夏鸥发布了新的文献求助10
5秒前
白学长应助67采纳,获得10
7秒前
张瀚文发布了新的文献求助10
7秒前
8秒前
eurhfe发布了新的文献求助10
9秒前
汉堡包应助redstone采纳,获得30
10秒前
西雅发布了新的文献求助10
11秒前
14秒前
15秒前
15秒前
科研通AI2S应助夏鸥采纳,获得10
17秒前
零零发布了新的文献求助10
18秒前
CipherSage应助熊猫采纳,获得10
20秒前
张智威发布了新的文献求助10
20秒前
22秒前
顾矜应助大海的DOI采纳,获得10
23秒前
24秒前
瘦瘦的怀绿完成签到 ,获得积分10
25秒前
S77应助王科采纳,获得10
25秒前
26秒前
27秒前
123完成签到 ,获得积分10
27秒前
27秒前
Orange应助标致安荷采纳,获得10
28秒前
寒冷乐驹发布了新的文献求助10
29秒前
29秒前
redstone发布了新的文献求助30
31秒前
刘鹏宇发布了新的文献求助30
32秒前
酷波er应助古月采纳,获得10
33秒前
寒冷的碧空关注了科研通微信公众号
34秒前
jianklf完成签到,获得积分10
35秒前
35秒前
38秒前
RONG完成签到 ,获得积分10
38秒前
redstone完成签到,获得积分10
39秒前
标致安荷发布了新的文献求助10
41秒前
zho应助街道办事部采纳,获得10
43秒前
高分求助中
Continuum Thermodynamics and Material Modelling 3000
Production Logging: Theoretical and Interpretive Elements 2700
Les Mantodea de Guyane Insecta, Polyneoptera 1000
Conference Record, IAS Annual Meeting 1977 820
England and the Discovery of America, 1481-1620 600
Teaching language in context (Third edition) by Derewianka, Beverly; Jones, Pauline 550
Typology of Conditional Constructions 500
热门求助领域 (近24小时)
化学 材料科学 生物 医学 工程类 有机化学 生物化学 物理 纳米技术 计算机科学 内科学 化学工程 复合材料 基因 遗传学 物理化学 催化作用 量子力学 光电子学 冶金
热门帖子
关注 科研通微信公众号,转发送积分 3585196
求助须知:如何正确求助?哪些是违规求助? 3154171
关于积分的说明 9500336
捐赠科研通 2856839
什么是DOI,文献DOI怎么找? 1570256
邀请新用户注册赠送积分活动 736109
科研通“疑难数据库(出版商)”最低求助积分说明 721514