Near-infrared fluorescence imaging-guided lymphatic mapping in thoracic esophageal cancer surgery
Purpose Identifying the lymphatic drainage pathway is important for accurate lymph node (LN) dissection in esophageal cancer (EC). This study aimed to assess lymphatic drainage mapping in thoracic EC using near-infrared fluorescent (NIRF) imaging with indocyanine green (ICG) and identify its feasibility for intraoperative LN drainage visualization and dissection. Methods From November 2019 to August 2020, esophagectomy was performed using intraoperative NIRF navigation with ICG injected into the esophageal submucosa by endoscopy. All LNs were divided into four groups according to the NIRF status and presence of metastasis: $ NIRF^{+} $$ LN^{+} $, $ NIRF^{+} $$ LN^{−} $, $ NIRF^{−} $$ LN^{+} $, and $ NIRF^{−} $$ LN^{−} $. Results Regional LNs were detected in all 84 enrolled patients with thoracic EC. A total of 2164 LNs were removed, and the mean number of dissected LNs was 25.68 ± 12.00. $ NIRF^{+} $ LNs were observed in all patients and distributed at 19 LN stations, which formed lymphatic drainage maps. The top five LN stations of $ NIRF^{+} $ probability in upper thoracic EC were No. 7, 106ecR, 107, 1, and 106recL; in middle thoracic EC, they were No. 107, 7, 110, 1, and 105; and in lower thoracic EC, they were No. 107, 7, 110, 106recR, and 1. There were no cases of ICG-related adverse events or chylothorax. The 30-day mortality rate was 0%. Major complications included anastomotic fistula (7.14%), pneumonia (4.76%), pleural effusion (13.10%), atelectasis (3.75%), hoarseness (8.33%), and arrhythmia (4.76%). Conclusion Regional LN mapping of thoracic EC was performed using ICG/NIRF imaging, which showed different preferred LN drainage stations in various anatomical locations of the thoracic esophagus. ICG/NIRF imaging is feasible for intraoperative LN drainage visualization and dissection. Clinical trial registration The clinical trial registration number is NCT04173676 (http://www.clinicaltrials.gov/)..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:36 |
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| Enthalten in: |
Surgical endoscopy and other interventional techniques - 36(2021), 6 vom: 07. Sept., Seite 3994-4003 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wang, Xiaojin [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Themen: |
Esophageal cancer |
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| RVK: |
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| Anmerkungen: |
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021 |
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| doi: |
10.1007/s00464-021-08720-7 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
OLC2130417477 |
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| 520 | |a Purpose Identifying the lymphatic drainage pathway is important for accurate lymph node (LN) dissection in esophageal cancer (EC). This study aimed to assess lymphatic drainage mapping in thoracic EC using near-infrared fluorescent (NIRF) imaging with indocyanine green (ICG) and identify its feasibility for intraoperative LN drainage visualization and dissection. Methods From November 2019 to August 2020, esophagectomy was performed using intraoperative NIRF navigation with ICG injected into the esophageal submucosa by endoscopy. All LNs were divided into four groups according to the NIRF status and presence of metastasis: $ NIRF^{+} $$ LN^{+} $, $ NIRF^{+} $$ LN^{−} $, $ NIRF^{−} $$ LN^{+} $, and $ NIRF^{−} $$ LN^{−} $. Results Regional LNs were detected in all 84 enrolled patients with thoracic EC. A total of 2164 LNs were removed, and the mean number of dissected LNs was 25.68 ± 12.00. $ NIRF^{+} $ LNs were observed in all patients and distributed at 19 LN stations, which formed lymphatic drainage maps. The top five LN stations of $ NIRF^{+} $ probability in upper thoracic EC were No. 7, 106ecR, 107, 1, and 106recL; in middle thoracic EC, they were No. 107, 7, 110, 1, and 105; and in lower thoracic EC, they were No. 107, 7, 110, 106recR, and 1. There were no cases of ICG-related adverse events or chylothorax. The 30-day mortality rate was 0%. Major complications included anastomotic fistula (7.14%), pneumonia (4.76%), pleural effusion (13.10%), atelectasis (3.75%), hoarseness (8.33%), and arrhythmia (4.76%). Conclusion Regional LN mapping of thoracic EC was performed using ICG/NIRF imaging, which showed different preferred LN drainage stations in various anatomical locations of the thoracic esophagus. ICG/NIRF imaging is feasible for intraoperative LN drainage visualization and dissection. Clinical trial registration The clinical trial registration number is NCT04173676 (http://www.clinicaltrials.gov/). | ||
| 650 | 4 | |a Esophageal cancer | |
| 650 | 4 | |a Intraoperative navigation | |
| 650 | 4 | |a Indocyanine green | |
| 650 | 4 | |a Near-infrared fluorescence imaging | |
| 650 | 4 | |a Lymphatic mapping | |
| 700 | 1 | |a Hu, Yi |4 aut | |
| 700 | 1 | |a Wu, Xiangwen |4 aut | |
| 700 | 1 | |a Liang, Mingzhu |4 aut | |
| 700 | 1 | |a Hu, Zhenhua |4 aut | |
| 700 | 1 | |a Gan, Xiangfeng |4 aut | |
| 700 | 1 | |a Li, Dan |4 aut | |
| 700 | 1 | |a Cao, Qingdong |4 aut | |
| 700 | 1 | |a Shan, Hong |4 aut | |
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