Assessment of the Completeness of Lymph Node Dissection Using Near-infrared Imaging with Indocyanine Green in Laparoscopic Gastrectomy for Gastric Cancer

김태한; 공성호; 박지호; 손영길; 허연주; 서윤석; 이혁준; 양한광

doi:https://doi.org/10.5230/jgc.2018.18.e19

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자료유형: 학술저널

저자정보: 김태한 (서울대학교병원) 공성호 (서울대학교병원) 박지호 (서울대학교) 손영길 (서울대학교) 허연주 (서울대학교) 서윤석 (서울대학교병원) 이혁준 (서울대학교) 양한광 (서울대학교)

저널정보: 대한위암학회 Journal of Gastric Cancer Journal of Gastric Cancer 제18권 제2호

발행연도: 2018.6

수록면: 161 - 171 (11page)

DOI: https://doi.org/10.5230/jgc.2018.18.e19

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Purpose: This study assessed the feasibility of near-infrared (NIR) imaging with indocyanine green (ICG) in investigating the completeness of laparoscopic lymph node (LN) dissection for gastric cancer. Materials and Methods: Patients scheduled for laparoscopic gastrectomy for treating gastric cancer were enrolled in the study. After intraoperative submucosal ICG injection (0.05 mg/mL), LN dissection was performed under conventional laparoscopic light. After dissection, the LN stations of interest were examined under the NIR mode to locate any extra ICG-stained (E) tissues, which were excised and sent for pathologic confirmation. This technique was tested in 2 steps: infra-pyloric LN dissection (step 1) and review of all stations after proper radical node dissection (step 2). Results: In step 1, 15 patients who underwent laparoscopic pylorus-preserving gastrectomy (LPPG) and 15 patients who underwent laparoscopic distal gastrectomy (LDG) were examined. Seven and 2 E-tissues were obtained during LPPG and LDG, respectively. From the retrieved E-tissues, 1 and 0 tissue obtained during LPPG and LDG, respectively, was confirmed as LN. In step 2, 20 patients were enrolled (13 D1+ dissection and 7 D2 dissection). Six E-tissues were retrieved from 5 patients, and 1 tissue was confirmed as LN in the pathologic review. Overall, 15 E-tissues were detected and removed, and 2 tissues were confirmed as LNs in the pathologic review. Both nodes were from LN station #6, with 1 case each in the LDG and LPPG groups. Conclusions: NIR imaging may provide additional node detection during laparoscopic LN dissection for gastric cancer, especially in the infra-pyloric area.

#Indocyanine green #NIR #Diagnostic imaging #Lymph nodes #Gastric cancer

참고문헌 (18)

참고문헌 신청

Kim JP / 1998 / Clinicopathologic characteristics and prognostic factors in 10 783 patients with gastric cancer / Gastric Cancer 1:125~133

Degiuli M / 2014 / Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer / Br J Surg 101:23~31

Tokunaga M / 2009 / Investigation of the lymphatic stream of the stomach in gastric cancer with solitary lymph node metastasis / World J Surg 33:1235~1239

Kong SH / 2015 / Evaluation of the novel near-infrared fluorescence tracers pullulan polymer nanogel and indocyanine green/$\gamma$-glutamic acid complex for sentinel lymph node navigation surgery in large animal models / Gastric Cancer 18:55~64

Shinohara H / 2013 / Topographic anatomy and laparoscopic technique for dissection of no. 6 infrapyloric lymph nodes in gastric cancer surgery / Gastric Cancer 16:615~620

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