Sejin Lee1,2, Jeong Ho Song1,2, Seohee Choi1,2, Minah Cho1,2, Yoo Min Kim1,2, Hyoung-Il Kim1,2, Woo Jin Hyung3,4. 1. Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea. 2. Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea. 3. Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea. wjhyung@yuhs.ac. 4. Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea. wjhyung@yuhs.ac.
Abstract
BACKGROUND: Fluorescent lymphography is an excellent technique for complete lymph node dissection during minimally invasive surgery for gastric cancer. This study aimed to evaluate the role of fluorescent lymphography in splenic hilar lymph node dissection during minimally invasive total gastrectomy. METHODS: We retrospectively analyzed 168 gastric cancer patients who underwent minimally invasive total gastrectomy with D2 + No. 10 lymph node dissection from 2013 to 2018. Fluorescent lymphography was used whenever it is possible. However, when near-infrared imaging system and endoscopic indocyanine green injection were not available, we performed surgery without fluorescent lymphography. A total of 74 patients underwent surgery with fluorescent lymphography (FL group) and 94 underwent surgery without it (non-FL group). Perioperative and long-term outcomes including the number of retrieved lymph nodes at each nodal station were compared between groups. RESULTS: The median number of retrieved lymph nodes at the splenic hilum was larger in the FL group {2.5 [Interquartile range (IQR), 1-5]} than in the non-FL group [1 (IQR, 1-3); P = 0.012]. The negative predictive value of fluorescent lymphography for lymph node metastasis at the splenic hilum was 97.1%, although the sensitivity was 66.7%. The overall survival (FL: 96.9% vs. non-FL: 88.9%; P = 0.334) and relapse-free survival (FL: 90.5% vs. non-FL: 65.5%; P = 0.054) were higher in the FL group, although there were no statistical differences. However, among the patients without lymph node metastasis, the relapse-free survival was significantly higher in the FL group (100%) than in the non-FL group (67.1%; P = 0.017). CONCLUSIONS: Fluorescent lymphography is an effective tool for complete lymph node dissection at the splenic hilum. Moreover, it may help select patients who do not need splenic hilar lymph node dissection during a total gastrectomy.
BACKGROUND: Fluorescent lymphography is an excellent technique for complete lymph node dissection during minimally invasive surgery for gastric cancer. This study aimed to evaluate the role of fluorescent lymphography in splenic hilar lymph node dissection during minimally invasive total gastrectomy. METHODS: We retrospectively analyzed 168 gastric cancer patients who underwent minimally invasive total gastrectomy with D2 + No. 10 lymph node dissection from 2013 to 2018. Fluorescent lymphography was used whenever it is possible. However, when near-infrared imaging system and endoscopic indocyanine green injection were not available, we performed surgery without fluorescent lymphography. A total of 74 patients underwent surgery with fluorescent lymphography (FL group) and 94 underwent surgery without it (non-FL group). Perioperative and long-term outcomes including the number of retrieved lymph nodes at each nodal station were compared between groups. RESULTS: The median number of retrieved lymph nodes at the splenic hilum was larger in the FL group {2.5 [Interquartile range (IQR), 1-5]} than in the non-FL group [1 (IQR, 1-3); P = 0.012]. The negative predictive value of fluorescent lymphography for lymph node metastasis at the splenic hilum was 97.1%, although the sensitivity was 66.7%. The overall survival (FL: 96.9% vs. non-FL: 88.9%; P = 0.334) and relapse-free survival (FL: 90.5% vs. non-FL: 65.5%; P = 0.054) were higher in the FL group, although there were no statistical differences. However, among the patients without lymph node metastasis, the relapse-free survival was significantly higher in the FL group (100%) than in the non-FL group (67.1%; P = 0.017). CONCLUSIONS: Fluorescent lymphography is an effective tool for complete lymph node dissection at the splenic hilum. Moreover, it may help select patients who do not need splenic hilar lymph node dissection during a total gastrectomy.
Authors: Nicole van der Wielen; Jennifer Straatman; Freek Daams; Riccardo Rosati; Paolo Parise; Jürgen Weitz; Christoph Reissfelder; Ismael Diez Del Val; Carlos Loureiro; Purificación Parada-González; Elena Pintos-Martínez; Francisco Mateo Vallejo; Carlos Medina Achirica; Andrés Sánchez-Pernaute; Adriana Ruano Campos; Luigi Bonavina; Emanuele L G Asti; Alfredo Alonso Poza; Carlos Gilsanz; Magnus Nilsson; Mats Lindblad; Suzanne S Gisbertz; Mark I van Berge Henegouwen; Uberto Fumagalli Romario; Stefano De Pascale; Khurshid Akhtar; H Jaap Bonjer; Miguel A Cuesta; Donald L van der Peet Journal: Gastric Cancer Date: 2021-01 Impact factor: 7.370
Authors: Francesco Belia; Alberto Biondi; Annamaria Agnes; Pietro Santocchi; Antonio Laurino; Laura Lorenzon; Roberto Pezzuto; Flavio Tirelli; Lorenzo Ferri; Domenico D'Ugo; Roberto Persiani Journal: Front Surg Date: 2022-06-28