Applicability of indocyanine green fluorescence tracing with subserosal dye injection in laparoscopic lymph node dissection for gastric cancer: a preliminary study

Abstract

Introduction: Gastric cancer is a common malignancy of the digestive system, primarily metastasizing to the lymph nodes. Adequate lymph node dissection is crucial for accurate staging and improving patient prognosis. However, the complex distribution of lymph nodes around the stomach poses a significant challenge for thorough dissection. Aim: This study aimed to evaluate the efficacy and safety of laparoscopic radical gastrectomy guided by indocyanine green (ICG) fluorescence imaging with subserosal ICG injection in lymph node dissection for gastric cancer. Materials and methods: This retrospective study included 20 patients who underwent distal gastrectomy at the Wenzhou People’s Hospital between January 2020 and December 2022. Of them, 10 patients underwent conventional laparoscopic surgery, and the other 10 underwent laparoscopic surgery guided by ICG fluorescence imaging. The 2 groups were propensity-matched for sex, age, and preoperative cancer stage. General patient characteristics, lymph node dissection data, and perioperative outcomes, such as procedure time, blood loss, and postoperative complications, were compared between the groups. Results: The total number of dissected lymph nodes was higher in the fluorescence-guided group than in the conventional surgery group, particularly in stations No. 6, 7, 8, 9, and 11p (all P <⁠0.001). There were no significant differences between the 2 groups in terms of procedure time, blood loss, and the incidence of postoperative complications. Conclusions: This preliminary study demonstrates that the use of ICG fluorescence imaging in minimally invasive radical gastrectomy can significantly increase the number of dissected lymph nodes without increasing the surgical risk.

Keywords

• fluorescence
• indocyanine green
• laparoscopic distal gastrectomy
• lymph node dissection