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Near-infrared fluorescence imaging-guided lymphatic mapping in thoracic esophageal cancer surgery
Surgical Endoscopy ( IF 3.1 ) Pub Date : 2021-09-07 , DOI: 10.1007/s00464-021-08720-7
Xiaojin Wang 1, 2 , Yi Hu 3, 4, 5 , Xiangwen Wu 1 , Mingzhu Liang 2 , Zhenhua Hu 6 , Xiangfeng Gan 1 , Dan Li 2 , Qingdong Cao 1 , Hong Shan 2, 7
Affiliation  

Purpose

Identifying the lymphatic drainage pathway is important for accurate lymph node (LN) dissection in esophageal cancer (EC). This study aimed to assess lymphatic drainage mapping in thoracic EC using near-infrared fluorescent (NIRF) imaging with indocyanine green (ICG) and identify its feasibility for intraoperative LN drainage visualization and dissection.

Methods

From November 2019 to August 2020, esophagectomy was performed using intraoperative NIRF navigation with ICG injected into the esophageal submucosa by endoscopy. All LNs were divided into four groups according to the NIRF status and presence of metastasis: NIRF+LN+, NIRF+LN, NIRFLN+, and NIRFLN.

Results

Regional LNs were detected in all 84 enrolled patients with thoracic EC. A total of 2164 LNs were removed, and the mean number of dissected LNs was 25.68 ± 12.00. NIRF+ LNs were observed in all patients and distributed at 19 LN stations, which formed lymphatic drainage maps. The top five LN stations of NIRF+ probability in upper thoracic EC were No. 7, 106ecR, 107, 1, and 106recL; in middle thoracic EC, they were No. 107, 7, 110, 1, and 105; and in lower thoracic EC, they were No. 107, 7, 110, 106recR, and 1. There were no cases of ICG-related adverse events or chylothorax. The 30-day mortality rate was 0%. Major complications included anastomotic fistula (7.14%), pneumonia (4.76%), pleural effusion (13.10%), atelectasis (3.75%), hoarseness (8.33%), and arrhythmia (4.76%).

Conclusion

Regional LN mapping of thoracic EC was performed using ICG/NIRF imaging, which showed different preferred LN drainage stations in various anatomical locations of the thoracic esophagus. ICG/NIRF imaging is feasible for intraoperative LN drainage visualization and dissection.

Clinical trial registration

The clinical trial registration number is NCT04173676 (http://www.clinicaltrials.gov/).



中文翻译:

近红外荧光成像引导的胸段食管癌手术淋巴标测

目的

识别淋巴引流通路对于食管癌 (EC) 中准确的淋巴结 (LN) 清扫非常重要。本研究旨在使用吲哚菁绿 (ICG) 的近红外荧光 (NIRF) 成像评估胸部 EC 的淋巴引流图,并确定其在术中 LN 引流可视化和解剖的可行性。

方法

从 2019 年 11 月至 2020 年 8 月,使用术中 NIRF 导航进行食管切除术,通过内窥镜将 ICG 注射到食管粘膜下层。根据 NIRF 状态和有无转移将所有 LN 分为四组:NIRF + LN +、NIRF + LN -、NIRF - LN +和 NIRF - LN -

结果

在所有 84 名登记的胸部 EC 患者中检测到区域 LN。共移除 2164 个 LN,平均解剖 LN 数为 25.68 ± 12.00。所有患者均观察到NIRF + LN,分布于 19 个 LN 站,形成淋巴引流图。上胸EC中NIRF +概率前5位的LN站分别为No.7、106ecR 、107、1、106recL;中胸EC分别为107、7、110、1、105;在下胸EC中,它们分别为107、7、110、106recR和1。没有ICG相关的不良事件或乳糜胸病例。30天死亡率为0%。主要并发症包括吻合口瘘(7.14%)、肺炎(4.76%)、胸腔积液(13.10%)、肺不张(3.75%)、声音嘶哑(8.33%)和心律失常(4.76%)。

结论

使用 ICG/NIRF 成像对胸部 EC 进行区域 LN 映射,显示在胸部食管的不同解剖位置有不同的首选 LN 引流站。ICG/NIRF 成像对于术中 LN 引流可视化和解剖是可行的。

临床试验注册

临床试验注册号为NCT04173676(http://www.clinicaltrials.gov/)。

更新日期:2021-09-08
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