Page 24 - Fluorescence-guided cancer surgery

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Chapter 2
ABSTRACT
Aim: To investigate feasibility and accuracy of near-infrared uorescence imaging using indocyanine green:nanocolloid for sentinel lymph node (SLN) detection in gastric cancer.
Methods: A prospective, single-institution, phase I feasibility trial was conducted. Patients su ering from gastric cancer and planned for gastrectomy were included. During surgery, a subserosal injection of 1.6mL ICG:Nanocoll was administered around the tumor. NIR uorescence imaging of the abdominal cavity was performed using the Mini-FLARETM NIR uorescence imaging system. Lymphatic pathways and SLNs were visualized. Of every detected SLN, the corresponding lymph node station, signal-to-background ratio and histopathological diagnosis was determined. Patients underwent standard-of- care gastrectomy. Detected SLNs outside the standard dissection planes were also resected and evaluated.
Results: Twenty-six patients were enrolled. Four patients were excluded because distant metastases were found during surgery or due to technical failure of the injection. In 21 of the remaining 22 patients, at least 1 SLN was detected by NIR uorescence (mean 3.1 SLNs; range 1-6). In 8 of the 21 patients, tumor-positive LNs were found. Overall accuracy of the technique was 90% (70-99%; 95% CI), which decreased by higher pT-stage (100%, 100%, 100%, 90%, 0% for respectively Tx, T1, T2, T3, T4 tumors). All NIR-negative SLNs were completely e aced by tumor. Mean uorescence signal-to-background ratio of SLNs was 4.4 (range 1.4-19.8). In 8 of the 21 patients, SLNs outside the standard resection plane were identi ed, that contained malignant cells in 2 patients.
Conclusions: This study shows successful use of ICG:Nanocoll as lymphatic tracer for SLN detection in gastric cancer. Moreover, tumor-containing LNs outside the standard dissection planes were identi ed.