Comparative study of ICG and non-ICG-guided laparoscopic gastrectomy for gastric cancer: a propensity score-matched analysis at a single center.

IF 2.1 Q2 SURGERY

BMJ Surgery Interventions Health Technologies Pub Date : 2025-03-05 eCollection Date: 2025-01-01 DOI:10.1136/bmjsit-2024-000313

Nguyen Van Du, Nguyen Anh Tuan, Luong Ngoc Cuong

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引用次数: 0

Abstract

Abstract:

Objectives: To investigate the effectiveness of indocyanine green (ICG) lymphography in improving lymph nodes (LNs) harvesting during laparoscopic radical distal gastrectomy for gastric cancer.

Design: Non-randomized trial, prospective study compared ICG and non-ICG group using 1:1 propensity score matching (PSM) method.

Setting: Preoperative clinical characteristics, operative outcomes, and follow-up results.

Participants: 242 patients who underwent laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer between 2019 and 2023. After exclusion and PSM, 160 patients (Pts) were included, paired in two groups: ICG (80 Pts) and non-ICG (80 Pts).

Interventions: Patients in the ICG group underwent ICG injection submucosal via endoscopy 1 day before surgery.

Main outcome measures: Comparison of the number of retrieved LNs and complications between the ICG and non-ICG group.

Results: There were no significant differences in age, sex, height, tumor size, pathological Tumor-stage, histological differentiation, and complications between the two groups. There was a shorter operative time in the ICG group compared with the non-ICG group (median: 118 mins (IQR, 105-135) vs 146 mins (IQR, 120-180), respectively). Regarding the effectiveness of LN dissection: the ICG group had a higher median of retrieved LNs than the non-ICG group (36 LNs (IQR, 29-46) vs 27 LNs (IQR, 21-31); p<0.001). The mean number of metastatic LNs in the ICG group was significantly higher than in the non-ICG group, with 2.6±5.4 LNs compared with 0.9±3.1 LNs, respectively (p=0.018). The proportion of patients with more than 25 and 30 retrieved LNs was higher in the ICG group compared with the non-ICG group, with rates of 86% and 71% versus 64% and 31%, respectively (p<0.001).

Conclusions: Using ICG fluorescence-guided LNs dissection has increased both the number of total LNs and metastatic LNs dissection without increasing complications in laparoscopic distal gastrectomy for gastric cancer.

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ICG与非ICG引导下腹腔镜胃癌切除术的比较研究：单中心倾向评分匹配分析

摘要：目的：探讨吲哚菁绿（ICG）淋巴造影术在腹腔镜胃癌根治性远端切除术中改善淋巴结（LNs）收获的效果。设计：非随机试验，前瞻性研究采用1:1倾向评分匹配（PSM）方法比较ICG组和非ICG组。背景：术前临床特征、手术结局及随访结果。参与者：242例在2019年至2023年间因胃癌接受腹腔镜胃远端切除术并D2淋巴结切除术的患者。排除和PSM后，纳入160例患者（Pts），分为两组：ICG组（80例）和非ICG组（80例）。干预措施：ICG组患者术前1天经内镜粘膜下注射ICG。主要观察指标：ICG组与非ICG组的取物数量及并发症比较。结果：两组患者在年龄、性别、身高、肿瘤大小、病理分期、组织学分化、并发症等方面均无统计学差异。与非ICG组相比，ICG组的手术时间更短（中位数：118分钟（IQR, 105-135） vs 146分钟（IQR, 120-180））。关于LN清扫的有效性：ICG组比非ICG组检索到的LN中位数更高(36个LN (IQR, 29-46) vs 27个LN (IQR, 21-31)；结论：在腹腔镜胃癌远端胃切除术中，应用ICG荧光引导下的LNs清扫可增加总LNs数量和转移性LNs清扫数量，但不增加并发症。

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