Diagnostic performance of fluorescent lymphography-guided lymph node dissection during minimally invasive gastrectomy following chemotherapy

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-03-02 DOI:10.1016/j.ejso.2025.109738

Ji Yoon Jeong , Ja Kyung Yoon , Jawon Hwang , Sung Hyun Park , Minah Cho , Yoo Min Kim , Hyoung-Il Kim , Hyunki Kim , Woo Jin Hyung

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引用次数: 0

Abstract

Introduction

Fluorescent lymphography-guided lymph node dissection (FL) using indocyanine green (ICG) during radical gastrectomy for gastric cancer has shown enhanced lymph node (LN) retrieval and high sensitivity in detecting LN metastases. However, the impact of FL during gastrectomy following chemotherapy remains uncertain because changes in the ICG injection site due to tumor shrinkage may potentially visualize different lymphatic drainage from the tumor. This study aimed to assess the diagnostic performance of FL during gastrectomy after preoperative chemotherapy.

Materials and Methods

This retrospective study included patients who underwent minimally invasive gastrectomy with FL following chemotherapy between January 2013 and February 2024. Patients were categorized according to their tumor response after chemotherapy based on endoscopic, radiologic, and pathological findings.

Results

Of 29 patients, 9.4 (range 8–12) LN stations containing 6.9 (range 3–11) fluorescent LN stations, which had 56.3 (range 33–99) LNs including 33.4 (range 11–68) fluorescent LNs, were retrieved per patient. While 52 metastatic LN stations were fluorescent, three non-fluorescent metastatic LN stations were identified in one patient (3.4 %). FL showed 94.5 % (52/55) sensitivity and 95.9 % (70/73) negative predictive value for detecting metastatic LN stations. There was no significant difference in the number of retrieved LNs and the sensitivity for detecting metastatic LN stations between responders and non-responders.

Conclusion

Tumor response after chemotherapy did not influence the diagnostic performance of FL. The diagnostic performance of FL during gastrectomy following chemotherapy was acceptable. Similar to upfront surgery, FL can be safely applied even after chemotherapy.

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化疗后微创胃切除术中荧光淋巴造影引导下淋巴结清扫的诊断价值

在胃癌根治术中使用吲哚菁绿（ICG）进行荧光淋巴造影引导下的淋巴结清扫（FL）显示出增强的淋巴结（LN）检索和对淋巴结转移的高灵敏度。然而，化疗后胃切除术中FL的影响仍然不确定，因为肿瘤缩小导致ICG注射部位的变化可能潜在地显示出肿瘤的不同淋巴引流。本研究旨在评估术前化疗后胃切除术中FL的诊断价值。材料与方法本回顾性研究纳入2013年1月至2024年2月化疗后行微创胃切除术合并FL的患者。根据化疗后的肿瘤反应，根据内镜、放射学和病理结果对患者进行分类。结果29例患者中，每例患者共检索到9.4个（范围8-12）LN站，其中6.9个（范围3-11）荧光LN站，其中56.3个（范围33-99）LN，其中33.4个（范围11-68）荧光LN。虽然有52个转移性LN站是荧光的，但在1例患者中发现了3个非荧光转移性LN站（3.4%）。FL检测淋巴结转移的敏感性为94.5%(52/55)，阴性预测值为95.9%（70/73）。在有反应者和无反应者之间，检索到的LN数量和检测转移性LN站点的敏感性没有显著差异。结论化疗后肿瘤反应不影响FL的诊断，化疗后胃切除术对FL的诊断是可以接受的。与前期手术类似，FL即使在化疗后也可以安全应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.