Importance Fluorescent imaging with indocyanine green can be used to visualize lymphatics. Peritumoral injection of indocyanine green may allow for visualization of every draining lymph node from a primary lesion on near-infrared imaging. Objectives To evaluate the role of fluorescent lymphography using near-infrared imaging as an intraoperative tool for achieving complete lymph node dissection and compare the number of lymph nodes retrieved with the use of near-infrared imaging and the number of lymph nodes retrieved without the use of near-infrared imaging. Design, Setting, and Participants This prospective single-arm study was conducted among 40 patients who underwent robotic gastrectomy between August 30, 2013, and July 21, 2014, at a single-center, tertiary referral teaching hospital. After propensity score matching, the results of these 40 patients were compared with the results of 40 historical control patients who underwent robotic gastrectomy without indocyanine green injection between January 1, 2012, and August 31, 2013. Statistical analysis was performed from January 1, 2015, to July 31, 2016. Interventions Robotic gastrectomy with systemic lymphadenectomy and retrieval of lymph nodes under near-infrared imaging after peritumoral injection of indocyanine green to the submucosal layer 1 day before surgery. Main Outcomes and Measures The primary outcome was the number of retrieved lymph nodes in each nodal station. Results Among the 40 patients in the study (19 women and 21 men; mean [SD] age, 52.2 [11.7] years), no complications related to indocyanine green injection or near-infrared imaging were observed. On completion of the lymphadenectomy, the absence of fluorescent lymph nodes in the dissected area was confirmed. A mean (SD) total of 23.9 (9.0) fluorescent lymph nodes were recorded among a mean (SD) total of 48.9 (14.6) overall lymph nodes retrieved. The mean number of overall lymph nodes retrieved was larger in the near-infrared group than in the historical controls (48.9 vs 35.2; P < .001), with a significantly greater number of lymph nodes retrieved at stations 2, 6, 7, 8, and 9. In the near-infrared group, 5 patients exhibited lymph node metastases, and all metastatic lymph nodes were fluorescent. Conclusions and Relevance This study's findings suggest that fluorescent lymphography may be useful intraoperatively for identifying and retrieving all necessary lymph nodes for a complete and thorough lymphadenectomy.

中文翻译：

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胃癌机器人根治性胃切除术中的荧光淋巴造影引导下的淋巴结清扫术。

重要性带有吲哚菁绿的荧光成像可用于可视化淋巴管。腹腔注射吲哚菁绿可以在近红外成像中观察原发灶的每个引流淋巴结。目的评估使用近红外成像作为完成完全淋巴结清扫术的术中工具的荧光淋巴成像的作用，并比较使用近红外成像获得的淋巴结数目和不使用淋巴结清扫的淋巴结数目。近红外成像。设计，设置和参加者这项前瞻性单臂研究是在2013年8月30日至2014年7月21日期间在一家单中心三级转诊教学医院接受机械胃切除术的40例患者中进行的。倾向得分匹配后，将这40例患者的结果与40例在2012年1月1日至2013年8月31日之间未进行吲哚菁绿注射的机器人胃切除术的历史对照患者的结果进行比较。统计分析时间为2015年1月1日至7月31日， 2016.干预：在手术前1天瘤周注射吲哚菁绿到粘膜下层后，机器人胃切除术结合全身淋巴结清扫术和在近红外成像下检索淋巴结。主要结果和措施主要结果是每个淋巴结中回收的淋巴结数目。结果在研究的40例患者中（19名女性和21名男性；平均[SD]年龄为52.2 [11.7]岁），未观察到与吲哚菁绿注射液或近红外成像相关的并发症。淋巴结清扫术完成后，确认解剖区域没有荧光淋巴结。记录的平均（SD）总数为23.9（9.0）个荧光淋巴结，其中检索到的平均（SD）总数为48.9（14.6）个淋巴结。在近红外组中检索到的总淋巴结平均数比历史对照组要多（48.9 vs 35.2； P <.001），在第2、6、7、8站检索到的淋巴结数量明显更多。 ，和9.在近红外组中，有5例患者出现淋巴结转移，所有转移性淋巴结均发荧光。结论与相关性这项研究的发现表明，荧光淋巴造影术可能在术中有助于识别和取回完整而彻底的淋巴结清扫术所需的所有淋巴结。