Evaluating Variations in Indocyanine Green Administration and Its Impact on Nodal Yield in Oesophagogastric Cancer Surgery.

Abstract

Background: Indocyanine green (ICG), a near-infrared fluorescent dye, has the potential to improve oncological outcomes by increasing lymph node yield in oesophagogastric (OG) cancer. There is no consensus regarding the dose, timing, and method of injection. This study was designed to evaluate the variation in ICG administration and its potential impact on nodal yield in OG cancer surgery for the purpose of translation in Western patients.

Methods: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The primary outcome of this review was nodal yield, and the secondary outcome was the diagnostic accuracy of ICG in detecting metastatic lymph nodes. A meta-analysis of diagnostic accuracy data was performed by using a random-effects model.

Results: A total of 38 studies (12,138 patients) were included in the analysis. Nodal yield was significantly increased in the ICG groups by 7.6 nodes (95% confidence interval [CI] 5.9-9.4; P = 0.0001) compared with control. Trends towards greater nodal yield were observed when ICG was administered at doses less than 2.75 mg, on the day before surgery, and via subserosal injection, although these did not reach statistical significance. Of the 17 studies with diagnostic accuracy data, the pooled sensitivity and specificity of ICG were 0.81 (95% CI 0.67-0.90) and 0.41 (95% CI 0.29-0.53), I² 90.5%.

Conclusions: Indocyanine green-assisted lymphadenectomy significantly increased lymph node yield, which may translate into improved survival in patients with OG cancer. The ICG dose, timing, and method of injection warrant standardisation to maximise its potential benefits in Western patients.