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Fluorescent lymphography during minimally invasive total gastrectomy for gastric cancer: an effective technique for splenic hilar lymph node dissection

Authors
 Sejin Lee  ;  Jeong Ho Song  ;  Seohee Choi  ;  Minah Cho  ;  Yoo Min Kim  ;  Hyoung-Il Kim  ;  Woo Jin Hyung 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.36(5) : 2914-2924, 2022-05 
Journal Title
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
ISSN
 0930-2794 
Issue Date
2022-05
MeSH
Coloring Agents ; Gastrectomy / methods ; Humans ; Lymph Node Excision / methods ; Lymph Nodes / diagnostic imaging ; Lymph Nodes / pathology ; Lymph Nodes / surgery ; Lymphatic Metastasis / pathology ; Lymphography / methods ; Neoplasm Recurrence, Local / surgery ; Retrospective Studies ; Stomach Neoplasms* / diagnostic imaging ; Stomach Neoplasms* / pathology ; Stomach Neoplasms* / surgery
Keywords
Fluorescent lymphography ; Minimally invasive gastrectomy ; Splenic hilar lymph node
Abstract
Background: Fluorescent lymphography is an excellent technique for complete lymph node dissection during minimally invasive surgery for gastric cancer. This study aimed to evaluate the role of fluorescent lymphography in splenic hilar lymph node dissection during minimally invasive total gastrectomy.

Methods: We retrospectively analyzed 168 gastric cancer patients who underwent minimally invasive total gastrectomy with D2 + No. 10 lymph node dissection from 2013 to 2018. Fluorescent lymphography was used whenever it is possible. However, when near-infrared imaging system and endoscopic indocyanine green injection were not available, we performed surgery without fluorescent lymphography. A total of 74 patients underwent surgery with fluorescent lymphography (FL group) and 94 underwent surgery without it (non-FL group). Perioperative and long-term outcomes including the number of retrieved lymph nodes at each nodal station were compared between groups.

Results: The median number of retrieved lymph nodes at the splenic hilum was larger in the FL group {2.5 [Interquartile range (IQR), 1-5]} than in the non-FL group [1 (IQR, 1-3); P = 0.012]. The negative predictive value of fluorescent lymphography for lymph node metastasis at the splenic hilum was 97.1%, although the sensitivity was 66.7%. The overall survival (FL: 96.9% vs. non-FL: 88.9%; P = 0.334) and relapse-free survival (FL: 90.5% vs. non-FL: 65.5%; P = 0.054) were higher in the FL group, although there were no statistical differences. However, among the patients without lymph node metastasis, the relapse-free survival was significantly higher in the FL group (100%) than in the non-FL group (67.1%; P = 0.017).

Conclusions: Fluorescent lymphography is an effective tool for complete lymph node dissection at the splenic hilum. Moreover, it may help select patients who do not need splenic hilar lymph node dissection during a total gastrectomy.
Full Text
https://link.springer.com/article/10.1007/s00464-021-08584-x
DOI
10.1007/s00464-021-08584-x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yoo Min(김유민)
Kim, Hyoung Il(김형일) ORCID logo https://orcid.org/0000-0002-6134-4523
Song, Jeong Ho(송정호)
Lee, Sejin(이세진)
Cho, Minah(조민아) ORCID logo https://orcid.org/0000-0003-3011-5813
Choi, Seo Hee(최서희)
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/188471
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