Laparoscopic, Endoscopic and Robotic Surgery (Sep 2023)
Superiority of indocyanine green-enhanced near-infrared fluorescence-guided imaging for laparoscopic lymph node dissection in patients with early-stage endometrial cancer: A retrospective cohort study
Abstract
Objective: Laparoscopic pelvic lymph node dissection (LPND), which is an effective therapy for endometrial cancer, is challenging because of the complexity of the procedure and the occurrence of postoperative complications. This study aimed to explore whether indocyanine green (ICG)-enhanced near-infrared (NIR) fluorescence-guided LPND is superior to LPND in the context of early-stage endometrial carcinoma. Methods: In this retrospective study, we included the medical records of 190 patients with early-stage endometrioid adenocarcinoma who underwent LPND at the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine between January 2019 and January 2021. Depending on whether ICG-enhanced NIR fluorescence guidance was used, the patients were assigned to the ICG group or non-ICG group. Patients were followed-up for one year after surgery. Data on demographic characteristics, pathological results, operative outcomes, and complications were collected and analyzed. Results: The baseline characteristics were comparable between the ICG group and non-ICG group, including age, BMI, pregnancy history, and preoperative hemoglobin. For surgical outcomes, the patients in ICG group had significantly lower intraoperative blood loss (50 mL vs. 120 mL, p < 0.001), less postoperative pelvic drainage time (4.14 ± 1.44 d vs. 5.70 ± 1.89 d, p = 0.001), shorter duration of hospital stay (5.26 ± 1.41 d vs. 7.37 ± 1.85 d, p = 0.003), higher number of positive pelvic lymph nodes (PLNs) (1 vs. 0, p = 0.003), and more PLN-positive cases (16.0% vs. 3.6%, p = 0.003) than the patients in non-ICG group. However, no significant differences were noted in blood transfusion requirement, operative time, hemoglobin level decreases, number of PLNs harvested, or the presence of lymphocysts between the two groups. Conclusion: Our study showed that ICG-enhanced NIR fluorescence-guided operation may improve the accuracy and safety of LPND.
