Purpose Recently, totally laparoscopic gastrectomy has been gradually accepted by surgeons worldwide for gastric cancer treatment. Complete dissection of the lymph nodes and the establishment of the surgical margin are the most important considerations for curative gastric cancer surgery. Previous studies have demonstrated that indocyanine green (ICG)-traced laparoscopic gastrectomy significantly improves the completeness of lymph node dissection. However, it remains difficult to identify the tumor location intraoperatively for gastric cancers that are staged ≤T3. Here, we investigated the feasibility of ICG fluorescence for lymph node mapping and tumor localization during totally laparoscopic distal gastrectomy. Materials and Methods Preoperative and perioperative data from consecutive patients with gastric cancer who underwent a totally laparoscopic distal gastrectomy were collected and analyzed. The patients were categorized into the ICG (n=61) or the non-ICG (n=75) group based on whether preoperative endoscopic mucosal ICG injection was performed. Results The ICG group had a shorter operation time and less intraoperative blood loss. Moreover, significantly more lymph nodes were harvested in the ICG group than the non-ICG group. No pathologically positive margin was found and there was no significant difference in either the proximal or distal surgical margins between the 2 groups. Conclusions Near-infrared fluorescence imaging with ICG can be successfully used in totally laparoscopic distal gastrectomy, and it contributes to both the completeness of D2 lymph node dissection and confirmation of the gastric transection line. Well-designed prospective randomized studies are needed in the future to fully validate our findings.

中文翻译：

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吲哚菁绿近红外荧光成像在全腹腔镜远端胃切除术中的应用

目的近来，全腹腔镜胃切除术已逐渐被全世界的外科医生接受用于胃癌的治疗。彻底清扫淋巴结和确定手术切缘是根治性胃癌手术最重要的考虑因素。以前的研究表明，吲哚菁绿（ICG）示踪腹腔镜胃切除术显着提高了淋巴结清扫的完整性。然而，对于分期≤T3的胃癌，术中确定肿瘤位置仍然很困难。在这里，我们研究了 ICG 荧光在完全腹腔镜远端胃切除术中用于淋巴结定位和肿瘤定位的可行性。材料和方法 收集和分析连续接受全腹腔镜远端胃切除术的胃癌患者的术前和围手术期数据。根据术前是否进行内镜黏膜 ICG 注射，将患者分为 ICG（n=61）或非 ICG（n=75）组。结果 ICG组手术时间更短，术中失血量更少。此外，在 ICG 组中收获的淋巴结明显多于非 ICG 组。未发现病理阳性切缘，两组近端或远端手术切缘均无显着差异。结论 ICG近红外荧光成像可成功应用于全腹腔镜远端胃切除术，它有助于D2淋巴结清扫的完整性和胃横断线的确认。未来需要精心设计的前瞻性随机研究来充分验证我们的发现。