BMJ Surgery, Interventions, & Health Technologies (Mar 2025)

Comparative study of ICG and non-ICG-guided laparoscopic gastrectomy for gastric cancer: a propensity score-matched analysis at a single center

  • Nguyen Anh Tuan,
  • Nguyen Van Du,
  • Luong Ngoc Cuong

DOI
https://doi.org/10.1136/bmjsit-2024-000313
Journal volume & issue
Vol. 7, no. 1

Abstract

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Objectives To investigate the effectiveness of indocyanine green (ICG) lymphography in improving lymph nodes (LNs) harvesting during laparoscopic radical distal gastrectomy for gastric cancer.Design Non-randomized trial, prospective study compared ICG and non-ICG group using 1:1 propensity score matching (PSM) method.Setting Preoperative clinical characteristics, operative outcomes, and follow-up results.Participants 242 patients who underwent laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer between 2019 and 2023. After exclusion and PSM, 160 patients (Pts) were included, paired in two groups: ICG (80 Pts) and non-ICG (80 Pts).Interventions Patients in the ICG group underwent ICG injection submucosal via endoscopy 1 day before surgery.Main outcome measures Comparison of the number of retrieved LNs and complications between the ICG and non-ICG group.Results There were no significant differences in age, sex, height, tumor size, pathological Tumor-stage, histological differentiation, and complications between the two groups. There was a shorter operative time in the ICG group compared with the non-ICG group (median: 118 mins (IQR, 105–135) vs 146 mins (IQR, 120–180), respectively). Regarding the effectiveness of LN dissection: the ICG group had a higher median of retrieved LNs than the non-ICG group (36 LNs (IQR, 29–46) vs 27 LNs (IQR, 21–31); p<0.001). The mean number of metastatic LNs in the ICG group was significantly higher than in the non-ICG group, with 2.6±5.4 LNs compared with 0.9±3.1 LNs, respectively (p=0.018). The proportion of patients with more than 25 and 30 retrieved LNs was higher in the ICG group compared with the non-ICG group, with rates of 86% and 71% versus 64% and 31%, respectively (p<0.001).Conclusions Using ICG fluorescence-guided LNs dissection has increased both the number of total LNs and metastatic LNs dissection without increasing complications in laparoscopic distal gastrectomy for gastric cancer.