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Near-infrared fluorescence imaging-guided lymphatic mapping in thoracic esophageal cancer surgery

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Abstract

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−, NIRF−LN+, and NIRF−LN−.

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/).

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Abbreviations

AJCC:

The American joint committee on cancer

EC:

Esophageal cancer

ICG:

Indocyanine green

ICG + :

ICG stained

ICG-:

ICG unstained

LN:

Lymph node

LN + :

Metastatic lymph node

LN-:

Non-metastatic lymph node

NPV:

Negative predictive value

PPV:

Positive predictive value

TNM:

Tumor-node-metastasis

UICC:

The Union for International Cancer Control

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Funding

This study was funded by the National Key R&D Program of China (2018YFC0910603).

Author information

Author notes

  1. Xiaojin Wang, Yi Hu, and Xiangwen Wu have contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China

    Xiaojin Wang, Xiangwen Wu, Xiangfeng Gan & Qingdong Cao

  2. Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 Meihua E. Road, Zhuhai, 519000, China

    Xiaojin Wang, Mingzhu Liang, Dan Li & Hong Shan

  3. Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Yi Hu

  4. Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China

    Yi Hu

  5. Guangdong Esophageal Cancer Institute (GECI), Guangzhou, China

    Yi Hu

  6. CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China

    Zhenhua Hu

  7. Center for Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China

    Hong Shan

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  1. Xiaojin Wang
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Corresponding authors

Correspondence to Dan Li, Qingdong Cao or Hong Shan.

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Disclosures

Xiaojin Wang, Yi Hu, Xiangwen Wu, Mingzhu Liang, Zhenhua Hu, Xiangfeng Gan, Dan Li, Qingdong Cao, and Hong Shan have no conflicts of interest to declare.

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Wang, X., Hu, Y., Wu, X. et al. Near-infrared fluorescence imaging-guided lymphatic mapping in thoracic esophageal cancer surgery. Surg Endosc 36, 3994–4003 (2022). https://doi.org/10.1007/s00464-021-08720-7

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