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Zhou J, Li R, Zhao S, Sun L, Wang J, Fu Y, Wang D. Sentinel Node Navigation Surgery for Early Gastric Cancer: A Narrative Review. Am J Clin Oncol 2024:00000421-990000000-00183. [PMID: 38587337 DOI: 10.1097/coc.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Early gastric cancer (EGC) refers to malignant tumor lesions that are limited to the mucosa and submucosa layers, regardless of the presence of lymph node metastasis. Typically, EGC has a low rate of perigastric lymph node metastasis, and long-term survival outcomes are good after radical surgical treatment. The primary objective of surgical treatment for EGC is to achieve functional preservation while ensuring a radical cure. Sentinel node navigation surgery (SNNS) is a surgical technique used in the treatment of EGC. This approach achieves functional preservation by limiting lymph node dissection and performing restrictive gastrectomy guided by intraoperative negative sentinel node (SN) biopsy. Despite the apparent improvement in the detection rate of SN with the emergence of various tracing dyes and laparoscopic fluorescence systems, the oncological safety of SNNS remains a controversial research topic. SNNS, as a true form of stomach preservation surgery that enhances the quality of life, has become a topic of interest in the EGC field. In recent years, scholars from Japan and South Korea have conducted extensive research on the feasibility and safety of SNNS in the treatment of EGC. This article aims to provide reference choices for surgeons treating EGC by reviewing relevant research on SNNS for EGC in recent years.
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Affiliation(s)
- Jiajie Zhou
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Ruiqi Li
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Shuai Zhao
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Longhe Sun
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jie Wang
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Yayan Fu
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Daorong Wang
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
- Northern Jiangsu People's Hospital, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Disease, Yangzhou, China
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2
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Pantelis AG, Machairiotis N, Stavros S, Disu S, Drakakis P. Current applications of indocyanine green (ICG) in abdominal, gynecologic and urologic surgery: a meta-review and quality analysis with use of the AMSTAR 2 instrument. Surg Endosc 2024; 38:511-528. [PMID: 37957300 DOI: 10.1007/s00464-023-10546-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Indocyanine green (ICG) is an injectable fluorochrome that has recently gained popularity as a means of assisting intraoperative visualization during laparoscopic and robotic surgery. Many systematic reviews and meta-analyses have been published. We conducted a meta-review to synthesize the findings of these studies. METHODS PubMed and Embase were searched to identify systematic reviews and meta-analyses coping with the uses of ICG in abdominal operations, including Metabolic Bariatric Surgery, Cholecystectomy, Colorectal, Esophageal, Gastric, Hepato-Pancreato-Biliary, Obstetrics and Gynecology (OG), Pediatric Surgery, Surgical Oncology, Urology, (abdominal) Vascular Surgery, Adrenal and Splenic Surgery, and Interdisciplinary tasks, until September 2023. We submitted the retrieved meta-analyses to qualitative analysis based on the AMSTAR 2 instrument. RESULTS We identified 116 studies, 41 systematic reviews (SRs) and 75 meta-analyses (MAs), spanning 2013-2023. The most thoroughly investigated (sub)specialties were Colorectal (6 SRs, 25 MAs), OG (9 SRs, 15 MAs), and HPB (4 SRs, 12 MAs). Interestingly, there was high heterogeneity regarding the administered ICG doses, routes, and timing. The use of ICG offered a clear benefit regarding anastomotic leak prevention, particularly after colorectal and esophageal surgery. There was no clear benefit regarding sentinel node detection after OG. According to the AMSTAR 2 tool, most meta-analyses ranked as "critically low" (34.7%) or "low" (58.7%) quality. There were only five meta-analyses (6.7%) that qualified as "moderate" quality, whereas there were no "high" quality reviews. CONCLUSIONS Regardless of the abundance of pertinent literature and reviews, surgeons should be cautious when interpreting their results on ICG use in abdominal surgery. Future reviews should focus on ensuring methodological vigor; establishing clear protocols of ICG dose, route of administration, and timing; and improving reporting quality. Other sources of data (e.g., registries) and novel methods of data analysis (e.g., machine learning) might also contribute to an enhanced role of ICG as a decision-making tool in surgery.
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Affiliation(s)
- Athanasios G Pantelis
- Mohak Bariatric and Robotic Surgery Center, Sri Aurobindo Medical College Campus, Indore-Ujjain Highway Near MR-10 Crossing, Indore, Madhya Pradesh, 453555, India.
| | - Nikolaos Machairiotis
- Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, School of Medicine, Attikon University Hospital, University of Athens, Athens, Greece
- Endometriosis Centre, London North West University Healthcare NHS Trust, Harrow, UK
| | - Sofoklis Stavros
- Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, School of Medicine, Attikon University Hospital, University of Athens, Athens, Greece
| | - Stewart Disu
- Endometriosis Centre, London North West University Healthcare NHS Trust, Harrow, UK
| | - Petros Drakakis
- Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, School of Medicine, Attikon University Hospital, University of Athens, Athens, Greece
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3
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Senent-Boza A, García-Fernández N, Alarcón-Del Agua I, Socas-Macías M, de Jesús-Gil Á, Morales-Conde S. Impact of tumor stage and neoadjuvant chemotherapy in fluorescence-guided lymphadenectomy during laparoscopic gastrectomy for gastric cancer: A propensity score-matched study in a western center. Surgery 2024; 175:380-386. [PMID: 38040597 DOI: 10.1016/j.surg.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/12/2023] [Accepted: 10/25/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND The use of indocyanine green fluorescence has been shown to be a safe and effective method for improving lymph node retrieval in patients with gastric cancer. However, previous studies have focused on early-stage tumors and/or the Asian population and excluded patients who received neoadjuvant treatment. METHODS In this study, 142 patients with gastric adenocarcinoma underwent laparoscopic gastrectomy at a Spanish hospital between January 2017 and December 2022. Of these, 42 patients received preoperative indocyanine green injection to guide lymphadenectomy. Their outcomes were compared to a retrospective cohort of 42 patients after 1:1 propensity score matching. RESULTS The feasibility of indocyanine green lymphatic mapping was 95.5%. No complications associated with indocyanine green injection were observed. The indocyanine green group had a significantly higher number of retrieved lymph nodes than the non-indocyanine green group (32.67 vs 25.14; P = .013). This statistically significant difference was maintained across subgroups of neoadjuvant treatment, non-obese patients, pT0 to 2 stage, and pN0 stage. In 47.6% of patients from the indocyanine green group, lymphadenectomy was extended outside the standard D2 dissection area based on indocyanine green uptake, but none of the retrieved lymph nodes were metastatic. There were no differences in postoperative complications and length of hospital stay between the 2 groups. CONCLUSION Indocyanine green-guided lymphadenectomy is safe and feasible and increases the number of retrieved lymph nodes compared to conventional lymphatic dissection, as well as in patients receiving neoadjuvant chemotherapy. The use of indocyanine green should be routine if available for guiding lymph node dissection in gastric cancer, regardless of tumor stage or previous neoadjuvant treatment. However, further studies are needed to determine the impact of this technique on disease-free and overall survival.
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Affiliation(s)
- Ana Senent-Boza
- Unit of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Virgen del Rocio University Hospital, Sevilla, Spain.
| | - Noelia García-Fernández
- Unit of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Virgen del Rocio University Hospital, Sevilla, Spain. https://twitter.com/ngarciafdez
| | - Isaías Alarcón-Del Agua
- Unit of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Virgen del Rocio University Hospital, Sevilla, Spain
| | - María Socas-Macías
- Unit of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Ángela de Jesús-Gil
- Unit of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Virgen del Rocio University Hospital, Sevilla, Spain. https://twitter.com/angeladejesuss
| | - Salvador Morales-Conde
- Unit of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Virgen del Rocio University Hospital, Sevilla, Spain; Department of Surgery, School of Medicine, University of Sevilla, Spain. https://twitter.com/smoralesconde
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4
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Niu S, Liu Y, Li D, Sheng Y, Zhang Y, Li Z, Zhao S, Wang T. Effect of indocyanine green near-infrared light imaging technique guided lymph node dissection on short-term clinical efficacy of minimally invasive radical gastric cancer surgery: a meta-analysis. Front Oncol 2023; 13:1257585. [PMID: 37766867 PMCID: PMC10520705 DOI: 10.3389/fonc.2023.1257585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Objective In recent years, the utilization of indocyanine green near-infrared (ICG NIR) light imaging-guided lymph node dissection in the context of minimally invasive radical gastric cancer has emerged as a novel avenue for investigation. The objective of this study was to assess the influence of employing this technique for guiding lymph node dissection on the short-term clinical outcomes of minimally invasive radical gastric cancer surgery. Methods The present study conducted a comprehensive search for short-term clinical outcomes, comparing the group undergoing ICG NIR light imaging-guided lymph node dissection with the control group, by thoroughly examining relevant literature from the inception to July 2023 in renowned databases such as PubMed, Embase, Web of Science, and Cochrane Library. The primary endpoints encompassed postoperative complications, including abdominal infection, abdominal bleeding, pneumonia, anastomotic fistula, and overall incidence of complications (defined as any morbidity categorized as Clavien-Dindo class I or higher within 30 days post-surgery or during hospitalization). Additionally, secondary outcome measures consisted of the time interval until the initiation of postoperative gas and food intake, as well as various other parameters, namely postoperative hospital stay, operative time, intraoperative blood loss, total number of harvested lymph nodes, and the number of harvested metastatic lymph nodes. To ensure methodological rigor, the Cochrane Collaboration Risk of Bias Tool and the Newcastle-Ottawa Scale (NOS) were employed to assess the quality of the included studies, while statistical analyses were performed using Review Manager 5.4 software and Stata, version 12.0 software. Results A total of 19 studies including 3103 patients were ultimately included (n=1276 in the ICG group and n=1827 in the non-ICG group). In this meta-analysis, the application of ICG near-infrared light imaging in minimally invasive radical gastric cancer surgery effectively improved the occurrence of postoperative Clavien-Dindo grade II or higher complications in patients (RR=0.72, 95% CI 0.52 to 1.00) with a statistically significant P=0.05; in reducing intraoperative blood loss and shortening While reducing intraoperative blood loss and shortening postoperative hospital stay, it could ensure the thoroughness of lymph node dissection in minimally invasive radical gastric cancer surgery (MD=5.575, 95% CI 3.677-7.473) with significant effect size (Z=5.76, p<0.00001). Conclusion The utilization of indocyanine green near-infrared light imaging technology in the context of minimally invasive radical gastric cancer surgery demonstrates notable efficacy in mitigating the occurrence of postoperative complications surpassing Clavien-Dindo grade II, while concurrently augmenting both the overall quantity of lymph node dissections and the identification of positive lymph nodes, all the while ensuring the preservation of surgical safety. Furthermore, the implementation of this technique proves particularly advantageous in the realm of robotic-assisted radical gastric cancer surgery, thus bearing significance for enhancing the short-term prognostic outcomes of patients.
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Affiliation(s)
- Sen Niu
- Department of General Surgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
| | - Yuan Liu
- Department of General Surgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
| | - Da Li
- Department of General Surgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
| | - Yufan Sheng
- Department of General Surgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
| | - Ye Zhang
- Department of General Surgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
| | - Zengyao Li
- Department of General Surgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
| | - Songyun Zhao
- Department of Neurosurgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
| | - Tong Wang
- Department of General Surgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
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5
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Shahin RK, Elkady MA, Abulsoud AI, Abdelmaksoud NM, Abdel Mageed SS, El-Dakroury WA, Zewail MB, Elazazy M, Sobhy MH, Nomier Y, Elazazy O, Elballal MS, Mohammed OA, Midan HM, Elrebehy MA, Ziada BO, Doghish AS. miRNAs orchestration of gallbladder cancer - Particular emphasis on diagnosis, progression and drug resistance. Pathol Res Pract 2023; 248:154684. [PMID: 37454489 DOI: 10.1016/j.prp.2023.154684] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
Gallbladder cancer (GBC) is characterized by a highly invasive nature and a poor prognosis, with adenocarcinoma being the main histological subtype. According to statistical data, patients diagnosed with advanced GBC have a survival rate of less than 5% for 5 years. Despite the novel therapeutic techniques, the unsatisfactory results could be related to the underlying biology of tumor cells and resistance to chemotherapy. Early diagnosis is more important than clinical therapy as it assists in determining the pathological stage of cancer and facilitates the selection of appropriate medication. Hence, it is very important to understand the precise pathogenesis of GBC and to discover potential novel biomarkers for early diagnosis of GBC. Non-coding RNAs, such as microRNAs, long non-coding RNAs, and circular RNAs, have been found to influence the transcriptional regulation of target genes associated with cancer, either directly or indirectly. microRNAs are a group of small, non-coding, single-stranded RNAs that are expressed endogenously. miRNAs play significant roles in various fundamental cellular processes. Therefore, miRNAs have the potential to serve as valuable biomarkers and therapeutic targets for GBC.
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Affiliation(s)
- Reem K Shahin
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Mohamed A Elkady
- Biochemistry and Molecular Biology Department, Faculty of Pharmacy (Boys), Al-Azhar University, Nasr City, 11231 Cairo, Egypt
| | - Ahmed I Abulsoud
- Biochemistry and Molecular Biology Department, Faculty of Pharmacy (Boys), Al-Azhar University, Nasr City, 11231 Cairo, Egypt; Biochemistry Department, Faculty of Pharmacy, Heliopolis University, Cairo 11785, Egypt
| | | | - Sherif S Abdel Mageed
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Walaa A El-Dakroury
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Moataz B Zewail
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Mahmoud Elazazy
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Mohamed H Sobhy
- Nanomedicine Research Labs, Center for Materials Science, Zewail City of Science and Technology, 6th of October City, Giza, Egypt
| | - Yousra Nomier
- Pharmacology Department, Pharmacy College, Jazan University, Saudi Arabia
| | - Ola Elazazy
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Mohammed S Elballal
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Osama A Mohammed
- Department of Clinical Pharmacology, Faculty of Medicine, Bisha University, Bisha 61922, Saudi Arabia; Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
| | - Heba M Midan
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt
| | - Mahmoud A Elrebehy
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt.
| | - Bassant O Ziada
- Research Department, Utopia Pharmaceuticals, Nasr City, 11765 Cairo, Egypt
| | - Ahmed S Doghish
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City, Cairo 11829, Egypt; Biochemistry and Molecular Biology Department, Faculty of Pharmacy (Boys), Al-Azhar University, Nasr City, 11231 Cairo, Egypt.
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6
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Wang X, Dai G, Jiang G, Zhang D, Wang L, Zhang W, Chen H, Cheng T, Zhou Y, Wei X, Li F, Ma D, Tan S, Wei R, Xi L. A TMVP1-modified near-infrared nanoprobe: molecular imaging for tumor metastasis in sentinel lymph node and targeted enhanced photothermal therapy. J Nanobiotechnology 2023; 21:130. [PMID: 37069646 PMCID: PMC10108508 DOI: 10.1186/s12951-023-01883-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/06/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND TMVP1 is a novel tumor targeting polypeptide screened by our laboratory with a core sequence of five amino acids LARGR. It specially binds to vascular endothelial growth factor receptor-3 (VEGFR-3), which is mainly expressed on neo-lymphatic vessels in sentinel lymph node (SLN) with tumor metastasis in adults. Here, we prepared a targeted nanoprobe using TMVP1-modified nanomaterials for tumor metastasis SLN imaging. RESULTS In this study, TMVP1-modified polymer nanomaterials were loaded with the near-infrared (NIR) fluorescent dye, indocyanine green (ICG), to prepare a molecular imaging TMVP1-ICG nanoparticles (NPs) to identify tumor metastasis in SLN at molecular level. TMVP1-ICG-NPs were successfully prepared using the nano-precipitation method. The particle diameter, morphology, drug encapsulation efficiency, UV absorption spectrum, cytotoxicity, safety, and pharmacokinetic properties were determined. The TMVP1-ICG-NPs had a diameter of approximately 130 nm and an ICG loading rate of 70%. In vitro cell experiments and in vivo mouse experiments confirmed that TMVP1-ICG-NPs have good targeting ability to tumors in situ and to SLN with tumor metastasis by binding to VEGFR-3. Effective photothermal therapy (PTT) with TMVP1-ICG-NPs was confirmed in vitro and in vivo. As expected, TMVP1-ICG-NPs improved ICG blood stability, targeted tumor metastasis to SLN, and enhanced PTT/photodynamic (PDT) therapy, without obvious cytotoxicity, making it a promising theranostic nanomedicine. CONCLUSION TMVP1-ICG-NPs identified SLN with tumor metastasis and were used to perform imaging-guided PTT, which makes it a promising strategy for providing real-time NIR fluorescence imaging and intraoperative PTT for patients with SLN metastasis.
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Affiliation(s)
- Xueqian Wang
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Geyang Dai
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Guiying Jiang
- Department of Gynecology, West China Second University Hospital, Chengdu, 610000, China
| | - Danya Zhang
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Ling Wang
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Wen Zhang
- Hubei University of Medicine, Shiyan, 442000, China
| | - Huang Chen
- School of Medicine, Jianghan University, Wuhan, 430000, China
| | - Teng Cheng
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ying Zhou
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Xiao Wei
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Fei Li
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Ding Ma
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Songwei Tan
- Tongji School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Rui Wei
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China.
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China.
| | - Ling Xi
- Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China.
- National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China.
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7
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Cassinotti E, Al-Taher M, Antoniou SA, Arezzo A, Baldari L, Boni L, Bonino MA, Bouvy ND, Brodie R, Carus T, Chand M, Diana M, Eussen MMM, Francis N, Guida A, Gontero P, Haney CM, Jansen M, Mintz Y, Morales-Conde S, Muller-Stich BP, Nakajima K, Nickel F, Oderda M, Parise P, Rosati R, Schijven MP, Silecchia G, Soares AS, Urakawa S, Vettoretto N. European Association for Endoscopic Surgery (EAES) consensus on Indocyanine Green (ICG) fluorescence-guided surgery. Surg Endosc 2023; 37:1629-1648. [PMID: 36781468 PMCID: PMC10017637 DOI: 10.1007/s00464-023-09928-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/28/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND In recent years, the use of Indocyanine Green (ICG) fluorescence-guided surgery during open and laparoscopic procedures has exponentially expanded across various clinical settings. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on this topic with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS An expert panel of surgeons has been selected and invited to participate to this project. Systematic reviews of the PubMed, Embase and Cochrane libraries were performed to identify evidence on potential benefits of ICG fluorescence-guided surgery on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by the panel; they were then submitted to all EAES members through a two-rounds online survey and results presented at the EAES annual congress, Barcelona, November 2021. RESULTS A total of 18,273 abstracts were screened with 117 articles included. 22 statements and 16 recommendations were generated and approved. In some areas, such as the use of ICG fluorescence-guided surgery during laparoscopic cholecystectomy, the perfusion assessment in colorectal surgery and the search for the sentinel lymph nodes in gynaecological malignancies, the large number of evidences in literature has allowed us to strongly recommend the use of ICG for a better anatomical definition and a reduction in post-operative complications. CONCLUSIONS Overall, from the systematic literature review performed by the experts panel and the survey extended to all EAES members, ICG fluorescence-guided surgery could be considered a safe and effective technology. Future robust clinical research is required to specifically validate multiple organ-specific applications and the potential benefits of this technique on clinical outcomes.
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Affiliation(s)
- E Cassinotti
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy.
| | - M Al-Taher
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - S A Antoniou
- Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - A Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - L Baldari
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - L Boni
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - M A Bonino
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R Brodie
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - T Carus
- Niels-Stensen-Kliniken, Elisabeth-Hospital, Thuine, Germany
| | - M Chand
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - M Diana
- IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - M M M Eussen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - N Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - A Guida
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - P Gontero
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - C M Haney
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Jansen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Y Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
| | - B P Muller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - K Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Oderda
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - P Parise
- U.O.C. Chirurgia Generale, Policlinico di Abano Terme, Abano Terme, PD, Italy
| | - R Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - M P Schijven
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, North Holland, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
| | - G Silecchia
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - A S Soares
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - S Urakawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - N Vettoretto
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Montichiari, Italy
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8
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Calcara C, Cocciolillo S, Marten Canavesio Y, Adamo V, Carenzi S, Lucci DI, Premoli A. Endoscopic fluorescent lymphography for gastric cancer. World J Gastrointest Endosc 2023; 15:32-43. [PMID: 36925646 PMCID: PMC10011894 DOI: 10.4253/wjge.v15.i2.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/18/2022] [Accepted: 02/07/2023] [Indexed: 02/13/2023] Open
Abstract
Lymphography by radioisotope or dye is a well-known technique for visualizing the lymphatic drainage pattern in a neoplastic lesion and it is in use in gastric cancer. Indocyanine green (ICG) more recently has been validated in fluorescent lymphography studies and is under evaluation as a novel tracer agent in gastric cancer. The amount and dilution of ICG injected as well as the site and the time of the injection are not standardized. In our unit, endoscopic submucosal injections of ICG are made as 0.5 mg in 0.5 mL at four peritumoral sites the day before surgery (for a total of 2.0 mg in 2.0 mL). Detection instruments for ICG fluorescence are evolving. Near-infrared systems integrated into laparoscopic or robotic instruments (near-infrared fluorescence imaging) have shown the most promising results. ICG fluorescence recognizes the node that receives lymphatic flow directly from a primary tumor. This is defined as the sentinel lymph node, and it has a high predictive negative value at the cT1 stage, able to reduce the extent of gastrectomy and lymph node dissection. ICG also enhances the number of lymph nodes detected during extended lymphadenectomy for advanced gastric cancer. Nevertheless, the practical effects of ICG use in a single patient are not yet clear. Standardization of the technique and further studies are needed before fluorescent lymphography can be used extensively worldwide. Until then, current guidelines recommend an extensive lymphadenectomy as the standard approach for gastric cancer with suspected metastasis.
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Affiliation(s)
| | - Sila Cocciolillo
- Digestive Endoscopy Unit, Padre Pio Hospital, Vasto 66054, Italy
| | | | - Vincenzo Adamo
- General Surgery Unit, S. Andrea Hospital, Vercelli 13100, Italy
| | - Silvia Carenzi
- Digestive Endoscopy Unit, S. Andrea Hospital, Vercelli 13100, Italy
| | | | - Alberto Premoli
- Digestive Endoscopy Unit, S. Andrea Hospital, Vercelli 13100, Italy
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9
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Pardo Aranda F, Gené Škrabec C, López-Sánchez J, Zarate Pinedo A, Espin Álvarez F, Cremades Pérez M, Navinés López J, Herrero Vicente C, Vidal Piñeiro L, Cugat Andorrà E. Indocyanine green (ICG) fluorescent cholangiography in laparoscopic cholecystectomy: Simplifying time and dose. Dig Liver Dis 2023; 55:249-253. [PMID: 36404235 DOI: 10.1016/j.dld.2022.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/15/2022] [Accepted: 10/23/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND This article aims to analyze and to simplify the optimal dose and time of intravenous indocyanine green (ICG) administration to achieve the identification of the cystic duct and the common bile duct (CBD). METHODS A consecutive series of 146 patients was prospectively analyzed and divided into three groups according to the time of ICG administration: at induction of anesthesia group (20-30 min); hours before group (between 2 and 6 h); and the day before group (≥6 h); and two groups according to the dose of ICG: 1 cc (2.5 mg) or weight-based dose (0.05 mg/kg). RESULTS The CBD was better visualized in the at induction of anesthesia group (85.4%), in the hours before group (97.1%) (p = 0.002) and in the 1cc group (p = 0.011). When we analyzed the 1 cc group (n = 126) a greater visualization of the CBD was observed in the at induction of anesthesia group (86.7%) and in the hours before group (97.1%) (p = 0.027). CONCLUSION Due to its simplicity and reproducibility, we suggest a dose of 2.5 mg administered 2-6 h before the procedure is the optimal. However, ICG administered 30 min prior to the surgery is enough for adequate visualization of biliary structures.
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Affiliation(s)
- Fernando Pardo Aranda
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Clara Gené Škrabec
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Jaime López-Sánchez
- Department of General and Digestive Surgery, Hospital Universitario de Salamanca, Spain
| | - Alba Zarate Pinedo
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Francisco Espin Álvarez
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Manel Cremades Pérez
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Jordi Navinés López
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Christian Herrero Vicente
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Laura Vidal Piñeiro
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Esteban Cugat Andorrà
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain; Department of General and Digestive Surgery, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
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10
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Cassinotti E, Boni L, Baldari L. Application of indocyanine green (ICG)-guided surgery in clinical practice: lesson to learn from other organs-an overview on clinical applications and future perspectives. Updates Surg 2023; 75:357-365. [PMID: 36203048 DOI: 10.1007/s13304-022-01361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/13/2022] [Indexed: 02/01/2023]
Abstract
Indocyanine green (ICG) fluorescence-guided surgery is a modality of intra-operative navigation that might support the surgeon with enhanced visualization of anatomical structures in real time. Over the last years, it has emerged as one of the most promising and rapidly developing technical innovations in surgery. The most popular current clinical applications include fluorescence cholangiography, bowel anastomotic perfusion assessment, fluorescence-guided lymphography for sentinel lymph-node identification and guided lymphadenectomy and the possible use in oncological surgery for the identification and localization of tumors and the diagnosis and treatment of peritoneal carcinosis. This paper provides an overview of the multiple fields of applications of ICG fluorescence-guided surgery in visceral and oncological surgery, discussing indications summarizing most recent and significative available literature and giving technical notes of use.
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Affiliation(s)
- E Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy.
| | - L Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - L Baldari
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
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11
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Rawicz-Pruszyński K, Sędłak K, Pelc Z, Mlak R, Litwiński J, Mańko P, Zinkiewicz K, Paśnik I, Cięszczyk K, Pawlik T, Märkl B, Erodotou M, Polkowski WP. Staging LaParoscopy to Assess Lymph NOde InvoLvement in Advanced GAstric Cancer (POLA)-Study protocol for a single-arm prospective observational multicenter study. PLoS One 2023; 18:e0285758. [PMID: 37205666 DOI: 10.1371/journal.pone.0285758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/25/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION In the era of neoadjuvant chemotherapy in advanced gastric cancer (GC), the role of staging laparoscopy (SL) will become more established. However, despite guidelines recommendations, SL for optimal preoperative staging remains underutilized. Diagnostic value of near-infrared (NIR) / indocyanine green (ICG) guided sentinel node (SN) mapping in GC confirmed its technical feasibility, however no data exist regarding its potential role in pathological nodal staging. To the best of our knowledge, current study is the first to evaluate the role of ICG in nodal staging of advanced GC patients undergoing SL. MATERIALS AND METHODS This single-arm prospective observational multicenter study was approved by the Bioethical Committee of Medical University of Lublin (Ethic Code: KE-0254/331/2018). The protocol is registered at clinicaltrial.gov (NCT05720598), and the study results will be reported according to the Strengthening of Reporting of Observational Studies in Epidemiology (STROBE) statement. The primary endpoint of this study is the identification rate of ICG-guided SN in advanced GC patients. The secondary endpoints include pathological and molecular assessment of retrieved SNs and other pretreatment clinical variables potentially associated with SL: pattern of perigastric ICG distribution according to patients' pathological and clinical characteristics, neoadjuvant chemotherapy compliance, 30-day morbidity, and mortality. CONCLUSION POLA study is the first to investigate the clinical value of ICG-enhanced sentinel node biopsy during staging laparoscopy in advanced GC patients in a Western cohort. Identifying pN status before multimodal treatment will improve GC staging process.
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Affiliation(s)
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Radosław Mlak
- Body Composition Research Laboratory, Department of Preclinical Sciences, Medical University of Lublin, Lublin, Poland
| | - Jakub Litwiński
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Paweł Mańko
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | | | - Iwona Paśnik
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Cięszczyk
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | - Timothy Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio, United States of America
| | - Bruno Märkl
- Institute of Pathology, Klinikum Augsburg, Augsburg, Germany
| | - Maria Erodotou
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
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12
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Dip F, Lo Menzo E, Bouvet M, Schols RM, Sherwinter D, Wexner SD, White KP, Rosenthal RJ. Intraoperative fluorescence imaging in different surgical fields: Consensus among 140 intercontinental experts. Surgery 2022; 172:S54-S59. [PMID: 36427931 DOI: 10.1016/j.surg.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/18/2022] [Accepted: 07/28/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite exponentially growing evidence supporting the use of intraoperative fluorescence imaging + indocyanine green dye, considerable variability exists in how and when it is used, and no published consensus guidelines exist. We have conducted Delphi surveys of international experts in the use of intraoperative fluorescence imaging covering 6 distinct surgical scenarios: laparoscopic cholecystectomy; colorectal, lymphedema, gastric cancer, and plastic surgery; and thyroid and parathyroid resections. Although each survey asked experts to vote on field-specific consensus statements, they also had 29 shared statements to permit some analysis spanning the 6 specialties. This article summarizes these results. METHODS Data on the 29 shared statements from 6 two-round Delphi consensus surveys were compiled to identify areas of overall consensus and compare the different specialties. As with the individual surveys, consensus was defined as ≥70% intervoter agreement. RESULTS Among 140 participating experts, overall consensus was achieved on 16 statements, including strong agreement that using indocyanine green is extremely safe, that it can be used even when informed written consent cannot be provided, that it significantly enhances anatomical visualization and impacts how procedures are performed, and that it significantly reduces overall procedural risk. However, indocyanine green dosing and timing are procedure-specific, with considerable variability persisting for some applications, and the overall consensus is that further research is necessary to optimize this facet of intraoperative fluorescence imaging. CONCLUSION Fluorescence imaging is gaining traction across multiple surgical specialties as an invaluable intraoperative tool. Its use in clinical practice and research seems destined to increase.
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Affiliation(s)
- Fernando Dip
- Hospital de Clínicas Jos e de San Martín, Buenos Aires, Argentina.
| | | | | | - Rutger M Schols
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Steven D Wexner
- Ellen Leifer Shulman amd Steven Shulman igestive Disease Center, Cleveland Clinic Florida, Weston, FL
| | - Kevin P White
- ScienceRight Research Consulting Services, London, Ontario, Canada
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13
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Sherwinter DA, Boni L, Bouvet M, Ferri L, Hyung WJ, Ishizawa T, Kaleya RN, Kelly K, Kokudo N, Lanzarini E, Luyer MDP, Mitsumori N, Mueller C, Park DJ, Ribero D, Rosati R, Ruurda JP, Sosef M, Schneider-Koraith S, Spinoglio G, Strong V, Takahashi N, Takeuchi H, Wijnhoven BPL, Yang HK, Dip F, Lo Menzo E, White KP, Rosenthal RJ. Use of fluorescence imaging and indocyanine green for sentinel node mapping during gastric cancer surgery: Results of an intercontinental Delphi survey. Surgery 2022; 172:S29-S37. [PMID: 36427927 PMCID: PMC9720539 DOI: 10.1016/j.surg.2022.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Understanding the extent of tumor spread to local lymph nodes is critical to managing early-stage gastric cancer. Recently, fluorescence imaging with indocyanine green has been used to identify and characterize sentinel lymph nodes during gastric cancer surgery, but no published guidelines exist. We sought to identify areas of consensus among international experts in the use of fluorescence imaging with indocyanine green for mapping sentinel lymph nodes during gastric-cancer surgery. METHODS In this 2-round, online Delphi survey, 27 international experts voted on 79 statements pertaining to patient preparation and contraindications to fluorescence imaging with indocyanine green during gastric cancer surgery; indications; technical aspects; advantages/disadvantages and limitations; and training and research. Methodological steps were adopted during survey design to minimize bias. RESULTS Consensus was reached on 61 of 79 statements, including giving single injections of indocyanine green into each of the 4 quadrants peritumorally, administering indocyanine green on the same day as surgery, injecting a total of 1 to 5 mL of 5 mg/mL indocyanine green, injecting endoscopically into submucosa, and repeating indocyanine green injections a second time if sentinel lymph node visualization remains inadequate. Consensus also was reached that fluorescence imaging with indocyanine green is an acceptable single-agent modality for sentinel lymph node identification and that the sentinel lymph node basin method is preferred. However, sentinel lymph node dissection should be limited to T1 gastric cancer and tumors ≤4 cm in diameter, and further research is necessary to optimize the technique and render fluorescence-guided sentinel lymph nodes dissection acceptable for routine clinical use. CONCLUSION Although considerable consensus was achieved, further research is necessary before this technology should be used in routine practice.
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Affiliation(s)
| | - Luigi Boni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Italy
| | | | | | - Woo Jin Hyung
- Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | | | - Norihiro Kokudo
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | | | | | - Doo Joong Park
- Seoul National University College of Medicine, Seoul, Korea
| | | | | | - Jelle P Ruurda
- UMC Utrecht Cancer Center, University Medical Center, Utrecht, the Netherlands
| | - Meindert Sosef
- Atrium Medisch Centrum Parkstad, Heerlen, the Netherlands
| | | | - Giuseppe Spinoglio
- FPO Candolo Institute for Cancer Research and Treatment IRCCS, Turin, Italy
| | - Vivian Strong
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Hiroya Takeuchi
- Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Bas P L Wijnhoven
- Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Fernando Dip
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | | | - Kevin P White
- ScienceRight Research Consulting, London, Ontario, Canada
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14
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Wexner S, Abu-Gazala M, Boni L, Buxey K, Cahill R, Carus T, Chadi S, Chand M, Cunningham C, Emile SH, Fingerhut A, Foo CC, Hompes R, Ioannidis A, Keller DS, Knol J, Lacy A, de Lacy FB, Liberale G, Martz J, Mizrahi I, Montroni I, Mortensen N, Rafferty JF, Rickles AS, Ris F, Safar B, Sherwinter D, Sileri P, Stamos M, Starker P, Van den Bos J, Watanabe J, Wolf JH, Yellinek S, Zmora O, White KP, Dip F, Rosenthal RJ. Use of fluorescence imaging and indocyanine green during colorectal surgery: Results of an intercontinental Delphi survey. Surgery 2022; 172:S38-S45. [PMID: 36427929 DOI: 10.1016/j.surg.2022.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fluorescence imaging with indocyanine green is increasingly being used in colorectal surgery to assess anastomotic perfusion, and to detect sentinel lymph nodes. METHODS In this 2-round, online, Delphi survey, 35 international experts were asked to vote on 69 statements pertaining to patient preparation and contraindications to fluorescence imaging during colorectal surgery, indications, technical aspects, potential advantages/disadvantages, and effectiveness versus limitations, and training and research. Methodological steps were adopted during survey design to minimize risk of bias. RESULTS More than 70% consensus was reached on 60 of 69 statements, including moderate-strong consensus regarding fluorescence imaging's value assessing anastomotic perfusion and leak risk, but not on its value mapping sentinel nodes. Similarly, although consensus was reached regarding most technical aspects of its use assessing anastomoses, little consensus was achieved for lymph-node assessments. Evaluating anastomoses, experts agreed that the optimum total indocyanine green dose and timing are 5 to 10 mg and 30 to 60 seconds pre-evaluation, indocyanine green should be dosed milligram/kilogram, lines should be flushed with saline, and indocyanine green can be readministered if bright perfusion is not achieved, although how long surgeons should wait remains unknown. The only consensus achieved for lymph-node assessments was that 2 to 4 injection points are needed. Ninety-six percent and 100% consensus were reached that fluorescence imaging will increase in practice and research over the next decade, respectively. CONCLUSION Although further research remains necessary, fluorescence imaging appears to have value assessing anastomotic perfusion, but its value for lymph-node mapping remains questionable.
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Affiliation(s)
- Steven Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL.
| | | | - Luigi Boni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Italy
| | - Kenneth Buxey
- Sandringham Hospital, Alfred Health, Melbourne, Australia
| | - Ronan Cahill
- UCD Centre of Precision Surgery, University College Dublin, Dublin, Ireland
| | - Thomas Carus
- Niels-Stensen-Kliniken, Elisabeth-Hospital, Thuine, Germany
| | - Sami Chadi
- University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | - Roel Hompes
- Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | | | - Deborah S Keller
- University of California at Davis Medical Center, Sacramento, CA
| | - Joep Knol
- Department of Abdominal Surgery, ZOL Hospital, Genk, Belgium
| | - Antonio Lacy
- Department of Abdominal Surgery, ZOL Hospital, Genk, Belgium
| | | | - Gabriel Liberale
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Ido Mizrahi
- Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | | | | | - Frederic Ris
- Geneva University Hospitals and Medical School, Geneva, Switzerland
| | | | | | | | | | | | | | - Jun Watanabe
- Yokohama City University Medical Center, Yokohama, Japan
| | - Joshua H Wolf
- Sinai Hospital of Baltimore, LifeBridge Health, Baltimore, MD
| | | | | | - Kevin P White
- ScienceRight Research Consulting, London, Ontario, Canada
| | - Fernando Dip
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Raul J Rosenthal
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
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15
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Li Z, Li X, Zhu X, Ai S, Guan W, Liu S. Tracers in Gastric Cancer Surgery. Cancers (Basel) 2022; 14:cancers14235735. [PMID: 36497216 PMCID: PMC9741333 DOI: 10.3390/cancers14235735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
The treatment of gastric cancer mainly depends on radical gastrectomy. Determination of appropriate surgical margins and adequate lymph node (LN) resection are two major surgical steps that directly correlate with prognosis in gastric cancer. Due to the expanding use of minimally invasive procedures, it is no longer possible to locate tumors and LNs through touch. As an alternative, tracers have begun to enter the field due to their capacities for intraoperative visualization. Herein, we summarize the application of contemporary tracers in gastric cancer surgery, including isosulfan blue, methylene blue, patent blue, indocyanine green, carbon particles, and radioactive tracers. Their mechanisms, administration methods, detection efficiency, and challenges, as well as perspectives on them, are also outlined.
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Affiliation(s)
| | | | | | | | - Wenxian Guan
- Correspondence: (W.G.); (S.L.); Tel.: +86-25-68182222-60931 (W.G.); +86-25-68182222-60930 (S.L.)
| | - Song Liu
- Correspondence: (W.G.); (S.L.); Tel.: +86-25-68182222-60931 (W.G.); +86-25-68182222-60930 (S.L.)
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16
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Müller D, Stier R, Straatman J, Babic B, Schiffmann L, Eckhoff J, Schmidt T, Bruns C, Fuchs HF. [ICG lymph node mapping in cancer surgery of the upper gastrointestinal tract]. CHIRURGIE (HEIDELBERG, GERMANY) 2022; 93:925-933. [PMID: 35925142 DOI: 10.1007/s00104-022-01659-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
The importance of the assessment of the N‑status in gastric carcinoma, tumors of the gastroesophageal junction and esophageal cancer is undisputed; however, there is currently no internationally validated method for lymph node mapping in esophageal and gastric cancer. Near-infrared fluorescence imaging (NIR) is an innovative technique from the field of vibrational spectroscopy, which in combination with the fluorescent dye indocyanine green (ICG) enables intraoperative real-time visualization of anatomical structures. The ICG currently has four fields of application in oncological surgery: intraoperative real-time angiography for visualization of perfusion, lymphography for visualization of lymphatic vessels, visualization of solid tumors, and (sentinel) lymph node mapping. For imaging of the lymph drainage area and therefore the consecutive lymph nodes, peritumoral injection of ICG must be performed. Several studies have demonstrated the feasibility of peritumoral injection of ICG administered 15 min to 3 days preoperatively with subsequent intraoperative visualization of the lymph nodes. So far prospective randomized studies on the validation of the method are still lacking. In contrast, the use of ICG for lymph node mapping and visualization of sentinel lymph nodes in gastric cancer has been performed in large cohorts as well as in prospective randomized settings. Up to now, multicenter studies for ICG-guided lymph node mapping during oncological surgery of the upper gastrointestinal tract are lacking. Artificial intelligence methods can help to evaluate these techniques in an automated manner in the future as well as to support intraoperative decision making and therefore to improve the quality of oncological surgery.
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Affiliation(s)
- Dolores Müller
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Raphael Stier
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Jennifer Straatman
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Benjamin Babic
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Lars Schiffmann
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Jennifer Eckhoff
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Thomas Schmidt
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Christiane Bruns
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Hans F Fuchs
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland.
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Kuznetsov D, Dezhurov S, Krylsky D, Novikov V, Neschisliaev V, Kuznetsova A. Use of folic acid nanosensors with excellent photostability for hybrid imaging. J Zhejiang Univ Sci B 2022; 23:784-790. [PMID: 36111575 DOI: 10.1631/jzus.b2200107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Sentinel lymph node (SLN) mapping and tumor-boundary delineation play a key role in cancer surgery, as they have great potential to reduce surgical intervention and increase relapse-free survival rates of patients. The autofluorescence imaging (AFI) method can improve the efficiency of tumor delineation and optimize the scope of surgical intervention, but there are still no fluorescent drugs that can be used with such a method to form a hybrid imaging technique. Another problem is bleaching when fluorescent dyes are conjugated with folic acid. This study reports, for the first time, nanosensors with excellent photostability and compatibility with endoscopes for AFI, which makes simultaneous hybrid imaging possible. After functionalization of the quantum dot (QD) surfaces, we found that they bound effectively to MCF-7 cancer cells. The diagnostic value of simultaneous hybrid imaging using common AFI equipment in delineating tumor boundaries and mapping SLN can reduce the cost of diagnosis and increase its reliability.
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Affiliation(s)
- Denis Kuznetsov
- G N. Gabrichevsky Scientific and Research Institute of Epidemiology and Microbiology, Moscow 125212, Russia. .,Perm State Pharmaceutical Academy, Perm 614990, Russia.
| | - Sergey Dezhurov
- Research Institute of Applied Acoustics, Center of High Technologies, Dubna 141980, Russia
| | - Dmitri Krylsky
- Research Institute of Applied Acoustics, Center of High Technologies, Dubna 141980, Russia
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18
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Li Y, Song Y, Zhang Y, Liu S. Progress in gallbladder cancer with lymph node metastasis. Front Oncol 2022; 12:966835. [PMID: 36072797 PMCID: PMC9441950 DOI: 10.3389/fonc.2022.966835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Gallbladder cancer (GBC) is a malignant tumor that originates from the mucosal lining of the gallbladder. It is distinctly regional and is common in certain geographic regions of developing countries. GBC has a high degree of insidiousness as well as a high propensity for metastatic spread, resulting in the majority of patients being diagnosed at an advanced stage. Lymph node metastasis (LNM) is fairly common in GBC patients and is an independent risk factor for a poor prognosis. This article is focused on the lymph node pathways and metastatic directions of GBC. Furthermore, it summarizes the different lymph node groupings, disease stages and treatments. In the future, it is of great significance to develop individualized treatment and predict the outcomes of GBC patients with different lymph node conditions.
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Affiliation(s)
- Yuhang Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yinghui Song
- Central Laboratory of Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yujing Zhang
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Sulai Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- Central Laboratory of Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, China
- *Correspondence: Sulai Liu,
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19
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Zhao J, Li K, Wang Z, Ke Q, Li J, Zhang Y, Zhou X, Zou Y, Song C. Efficacy and safety of indocyanine green tracer-guided lymph node dissection in minimally invasive radical gastrectomy for gastric cancer: A systematic review and meta-analysis. Front Oncol 2022; 12:884011. [PMID: 35992827 PMCID: PMC9388933 DOI: 10.3389/fonc.2022.884011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background The implementation of indocyanine green (ICG) tracer-guided lymph node dissection is still in the preliminary stages of laparoscopic surgery, and its safety and efficacy for gastric cancer remain unclear. Methods A systematic review was conducted in PubMed, Embase, Web of Science, the Cochrane Library, and Scopus to identify relevant subjects from inception to June 2022. The core indicators were the total number of harvested lymph nodes and the safety of the laparoscopic gastrectomy with ICG. A meta-analysis was performed to estimate the pooled weighted mean difference (WMD) and 95% confidence interval (CI). Results Thirteen studies and 2,027 participants were included (642 for the ICG-group and 1,385 for the non-ICG group). The mean number of lymph nodes dissected in the ICG group was significantly greater than that in the non-ICG group (WMD = 6.24, 95% CI: 4.26 to 8.22, P <0.001). However, there was no significant difference in the mean number of positive lymph nodes dissected between the ICG and the non-ICG groups (WMD = 0.18, 95% CI: −0.70 to 1.07, P = 0.879). Additionally, ICG gastrectomy did not increase the risk in terms of the operative time, estimated blood loss, and postoperative complications. Conclusion ICG tracer with favorable safety increases the number of harvested lymph nodes but not the number of positive lymph nodes in laparoscopic gastrectomy. More high-quality, large-sample-size randomized controlled trials are still needed to enhance this evidence.
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Affiliation(s)
- Jixiang Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ke Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Surgical Oncology, Capital Medical University, Beijing, China
| | - Zikang Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Gastroenterolog, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingqing Ke
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiapu Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yizhen Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaojiang Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yunzhi Zou
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Surgical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- *Correspondence: Yunzhi Zou, ; Conghua Song,
| | - Conghua Song
- Department of Gastroenterology, The Affiliated Hospital (Group) of Putian University, Putian, China
- *Correspondence: Yunzhi Zou, ; Conghua Song,
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20
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Dip F, Boni L, Bouvet M, Carus T, Diana M, Falco J, Gurtner GC, Ishizawa T, Kokudo N, Lo Menzo E, Low PS, Masia J, Muehrcke D, Papay FA, Pulitano C, Schneider-Koraith S, Sherwinter D, Spinoglio G, Stassen L, Urano Y, Vahrmeijer A, Vibert E, Warram J, Wexner SD, White K, Rosenthal RJ. Consensus Conference Statement on the General Use of Near-infrared Fluorescence Imaging and Indocyanine Green Guided Surgery: Results of a Modified Delphi Study. Ann Surg 2022; 275:685-691. [PMID: 33214476 PMCID: PMC8906245 DOI: 10.1097/sla.0000000000004412] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In recent decades, the use of near-infrared light and fluorescence-guidance during open and laparoscopic surgery has exponentially expanded across various clinical settings. However, tremendous variability exists in how it is performed. OBJECTIVE In this first published survey of international experts on fluorescence-guided surgery, we sought to identify areas of consensus and nonconsensus across 4 areas of practice: fundamentals; patient selection/preparation; technical aspects; and effectiveness and safety. METHODS A Delphi survey was conducted among 19 international experts in fluorescence-guided surgery attending a 1-day consensus meeting in Frankfurt, Germany on September 8th, 2019. Using mobile phones, experts were asked to anonymously vote over 2 rounds of voting, with 70% and 80% set as a priori thresholds for consensus and vote robustness, respectively. RESULTS Experts from 5 continents reached consensus on 41 of 44 statements, including strong consensus that near-infrared fluorescence-guided surgery is both effective and safe across a broad variety of clinical settings, including the localization of critical anatomical structures like vessels, detection of tumors and sentinel nodes, assessment of tissue perfusion and anastomotic leaks, delineation of segmented organs, and localization of parathyroid glands. Although the minimum and maximum safe effective dose of ICG were felt to be 1 to 2 mg and >10 mg, respectively, there was strong consensus that determining the optimum dose, concentration, route and timing of ICG administration should be an ongoing research focus. CONCLUSIONS Although fluorescence imaging was almost unanimously perceived to be both effective and safe across a broad range of clinical settings, considerable further research remains necessary to optimize its use.
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Affiliation(s)
- Fernando Dip
- Hospital de Clinicas Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina
- Cleveland Clinic Florida, Weston, FL
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico University of Milan, Milan, Italy
| | | | | | - Michele Diana
- IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France
| | - Jorge Falco
- University Hospital Das Clinicas, Buenos Aires, Argentina
| | | | | | - Norihiro Kokudo
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | | | | | - Francis A Papay
- Cleveland Clinic, Lerner College of Medicine at Case Western Reserve University, Cleveland, OH
| | | | | | | | - Giuseppe Spinoglio
- FPO Candolo Institute for Cancer Research and Treatment I.R.C.C.S, Turin, Italy
| | - Laurents Stassen
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Eric Vibert
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France
| | - Jason Warram
- University of Alabama at Birmingham, Birmingham, AL
| | | | - Kevin White
- ScienceRight Research Consulting London, Ontario, Canada
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21
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Lombardi PM, Mazzola M, Nicastro V, Giacopuzzi S, Baiocchi GL, Castoro C, Rosati R, Fumagalli Romario U, Bonavina L, Staderini F, Gockel I, Gregori D, De Martini P, Gualtierotti M, Danieli M, Beretta S, Mutignani M, Forti E, Ferrari G. The iGreenGO Study: The Clinical Role of Indocyanine Green Imaging Fluorescence in Modifying the Surgeon’s Conduct During the Surgical Treatment of Advanced Gastric Cancer—Study Protocol for an International Multicenter Prospective Study. Front Oncol 2022; 12:854754. [PMID: 35372091 PMCID: PMC8968043 DOI: 10.3389/fonc.2022.854754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background The near-infrared/indocyanine green imaging fluorescence (NIR/ICG) technology is showing promising results in several fields of surgical oncology. The clinical value of NIR/ICG technology in the surgical treatment of advanced gastric cancer (AGC) is not clearly established. Methods This is the protocol of the “iGreenGO” (indocyanine Green Gastric Observation) Study, a national prospective multicenter study. Western patients who undergo curative-intent gastrectomy with D2 lymphadenectomy for AGC constitute the study cohort. All the patients undergo preoperative upper gastrointestinal endoscopy for submucosal peritumoral ICG injection at the most 20 h before surgery. Intraoperative endoscopic injection before starting surgical dissection is also allowed. The primary endpoint is the “change in the surgical conduct” (CSC), i.e., the need to perform further dissection after intraoperative NIR/ICG technology activation at the end of D2 lymphadenectomy. Secondary endpoints include the pattern of abdominal fluorescence distribution according to tumor and patient characteristics, the preoperative clinical variables potentially associated with CSC, and the incidence of stage migration due to NIR/ICG application. Discussion The iGreenGO Study is the first study to investigate the clinical role of NIR/ICG technology for the surgical treatment of AGC in a large cohort of Western patients. Results from the present study can further clarify the role of NIR/ICG technology in surgical lymphadenectomy for AGC.
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Affiliation(s)
- Pietro Maria Lombardi
- Unit of Foregut Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- *Correspondence: Pietro Maria Lombardi, ; ; orcid.org/0000-0002-2633-7977
| | - Michele Mazzola
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Vincenzo Nicastro
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, University of Verona, Verona, Italy
| | - Gian Luca Baiocchi
- General Surgery, ASST Cremona, Cremona, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carlo Castoro
- Unit of Foregut Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, Policlinico San Donato, University of Milan, Milan, Italy
| | - Fabio Staderini
- Digestive Surgery Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital of Florence, Florence, Italy
| | - Ines Gockel
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Paolo De Martini
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Monica Gualtierotti
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Danieli
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Simona Beretta
- Data Management Unit, Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimiliano Mutignani
- Department of Digestive Endoscopy, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Edoardo Forti
- Department of Digestive Endoscopy, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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22
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Onishi T, Mihara K, Matsuda S, Sakamoto S, Kuwahata A, Sekino M, Kusakabe M, Handa H, Kitagawa Y. Application of Magnetic Nanoparticles for Rapid Detection and In Situ Diagnosis in Clinical Oncology. Cancers (Basel) 2022; 14:cancers14020364. [PMID: 35053527 PMCID: PMC8774179 DOI: 10.3390/cancers14020364] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 12/26/2022] Open
Abstract
Screening, monitoring, and diagnosis are critical in oncology treatment. However, there are limitations with the current clinical methods, notably the time, cost, and special facilities required for radioisotope-based methods. An alternative approach, which uses magnetic beads, offers faster analyses with safer materials over a wide range of oncological applications. Magnetic beads have been used to detect extracellular vesicles (EVs) in the serum of pancreatic cancer patients with statistically different EV levels in preoperative, postoperative, and negative control samples. By incorporating fluorescence, magnetic beads have been used to quantitatively measure prostate-specific antigen (PSA), a prostate cancer biomarker, which is sensitive enough even at levels found in healthy patients. Immunostaining has also been incorporated with magnetic beads and compared with conventional immunohistochemical methods to detect lesions; the results suggest that immunostained magnetic beads could be used for pathological diagnosis during surgery. Furthermore, magnetic nanoparticles, such as superparamagnetic iron oxide nanoparticles (SPIONs), can detect sentinel lymph nodes in breast cancer in a clinical setting, as well as those in gallbladder cancer in animal models, in a surgery-applicable timeframe. Ultimately, recent research into the applications of magnetic beads in oncology suggests that the screening, monitoring, and diagnosis of cancers could be improved and made more accessible through the adoption of this technology.
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Affiliation(s)
- Tatsuya Onishi
- Department of Breast Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa 277-8577, Chiba, Japan;
| | - Kisyo Mihara
- Department of Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki-ku, Kawasaki 210-0013, Kanagawa, Japan;
| | - Sachiko Matsuda
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;
- Correspondence: ; Tel.: +81-3-3353-1211
| | - Satoshi Sakamoto
- School of Life Science and Technology, Tokyo Institute of Technology, 4259 Nagatsuta-cho, Midori-ku, Yokohama 226-8501, Kanagawa, Japan;
| | - Akihiro Kuwahata
- Graduate School of Engineering, Tohoku University, 6-6-05 Aoba, Aramaki-aza, Aoba-ku, Sendai 980-8579, Miyagi, Japan;
| | - Masaki Sekino
- Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan;
| | - Moriaki Kusakabe
- Graduate School of Agricultural and Life Sciences, Research Center for Food Safety, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan;
- Matrix Cell Research Institute Inc., 1-35-3 Kamikashiwada, Ushiku 300-1232, Ibaraki, Japan
| | - Hiroshi Handa
- Department of Nanoparticle Translational Research, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan;
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;
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23
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Multifunctional Cyanine-Based Theranostic Probe for Cancer Imaging and Therapy. Int J Mol Sci 2021; 22:ijms222212214. [PMID: 34830094 PMCID: PMC8625430 DOI: 10.3390/ijms222212214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/04/2021] [Accepted: 11/10/2021] [Indexed: 02/06/2023] Open
Abstract
Cancer is one of the leading causes of death in the world. A cancer-targeted multifunctional probe labeled with the radionuclide has been developed to provide multi-modalities for NIR fluorescence and nuclear imaging (PET, SPECT), for photothermal therapy (PTT), and targeted radionuclide therapy of cancer. In this study, synthesis, characterization, in vitro, and in vivo biological evaluation of the cyanine-based probe (DOTA-NIR790) were demonstrated. The use of cyanine dyes for the selective accumulation of cancer cells were used to achieve the characteristics of tumor markers. Therefore, all kinds of organ tumors can be targeted for diagnosis and treatment. The DOTA-NIR790 labeled with lutetium-111 could detect original or metastatic tumors by using SPECT imaging and quantify tumor accumulation. The β-emission of 177Lu-DOTA-NIR790 can be used for targeted radionuclide therapy of tumors. The DOTA-NIR790 enabled imaging by NIR fluorescence and by nuclear imaging (SPECT) to monitor in real-time the tumor accumulation and the situation of cancer therapy, and to guide the surgery or the photothermal therapy of the tumor. The radionuclide-labeled heptamethine cyanine based probe (DOTA-NIR790) offers multifunctional modalities for imaging and therapies of cancer.
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24
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Peltrini R, Podda M, Castiglioni S, Di Nuzzo MM, D'Ambra M, Lionetti R, Sodo M, Luglio G, Mucilli F, Di Saverio S, Bracale U, Corcione F. Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art. World J Gastroenterol 2021; 27:6374-6386. [PMID: 34720528 PMCID: PMC8517789 DOI: 10.3748/wjg.v27.i38.6374] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/01/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
Indocyanine green (ICG) fluorescence imaging is widely used in abdominal surgery. The implementation of minimally invasive rectal surgery using new methods like robotics or a transanal approach required improvement of optical systems. In that setting, ICG fluorescence optimizes intraoperative vision of anatomical structures by improving blood and lymphatic flow. The purpose of this review was to summarize all potential applications of this upcoming technology in rectal cancer surgery. Each type of use has been separately addressed and the evidence was investigated. During rectal resection, ICG fluorescence angiography is mainly used to evaluate the perfusion of the colonic stump in order to reduce the risk of anastomotic leaks. In addition, ICG fluorescence imaging allows easy visualization of organs such as the ureter or urethra to protect them from injury. This intraoperative technology is a valuable tool for conducting lymph node dissection along the iliac lymphatic chain or to better identifying the rectal dissection planes when a transanal approach is performed. This is an overview of the applications of ICG fluorescence imaging in current surgical practice and a synthesis of the results obtained from the literature. Although further studies are need to investigate the real clinical benefits, these findings may enhance use of ICG fluorescence in current clinical practice and stimulate future research on new applications.
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Affiliation(s)
- Roberto Peltrini
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital "Duilio Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari 09100, Italy
| | - Simone Castiglioni
- Department of Medical, Oral and Biotechnological Sciences, University G. D’Annunzio Chieti-Pescara, Pescara 65100, Italy
| | | | - Michele D'Ambra
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Ruggero Lionetti
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Maurizio Sodo
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Gaetano Luglio
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Felice Mucilli
- Department of Medical, Oral and Biotechnological Sciences, University G. D’Annunzio Chieti-Pescara, Pescara 65100, Italy
| | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, ASST Sette Laghi, Varese 21100, Italy
| | - Umberto Bracale
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
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25
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Urabe F, Kimura S, Yasue K, Yanagisawa T, Tsuzuki S, Kimura T, Miki J, Egawa S. Performance of Indocyanine Green Fluorescence for Detecting Lymph Node Metastasis in Prostate Cancer: A Systematic Review and Meta-analysis. Clin Genitourin Cancer 2021; 19:466.e1-466.e9. [PMID: 34130916 DOI: 10.1016/j.clgc.2021.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/07/2021] [Accepted: 03/13/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE The use of sentinel lymph node dissection in several cancers has been gaining attention with the emergence of indocyanine green fluorescence. We performed a meta-analysis to assess the diagnostic performance of indocyanine green fluorescence in detecting lymph node metastasis in prostate cancer patients. METHODS A literature search was conducted using PubMed, Cochrane Library, and SCOPUS on November 30, 2020, to identify eligible studies. Studies were eligible if they investigated the diagnostic performance of indocyanine green fluorescence before pelvic lymph node dissection in prostate cancer patients and reported the number of true positives, false positives, false negatives, and true negatives on lymph node-based analysis in comparison to histopathologic findings in the dissected specimen. RESULTS Our systematic review covered 11 studies published between 2011 and 2020, with 519 patients, and our meta-analysis included 9 studies with 479 patients. Based on lymph node analysis of indocyanine green fluorescence, the results showed pooled sensitivity and specificity at 0.75 (95% confidence interval [CI] 0.49 to 0.90) and 0.66 (95% CI 0.61 to 0.70), respectively. The diagnostic odds ratio was 6.0 (95%CI 2 to 21). Several lymphatic drainage routes also showed sentinel lymph nodes localized outside the ordinal pelvic lymph node template. CONCLUSIONS We noted relatively low diagnostic performance for lymph node metastasis, suggesting that indocyanine fluorescence may not currently be a viable alternative to pelvic lymph node dissection in prostate cancer patients. However, this technique shows novel lymphatic drainage routes and underscores the importance of lymph nodes not removed in ordinary dissection.
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Affiliation(s)
- Fumihiko Urabe
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
| | - Shoji Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Keiji Yasue
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Yanagisawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei Kashiwa Hospital, Chiba, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei Kashiwa Hospital, Chiba, Japan
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
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26
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Enei Y, Urabe F, Miki J, Iwatani K, Hisakane A, Yasue K, Yanagisawa T, Kimura T, Egawa S. Clear identification of the rare solitary external iliac lymph node metastasis of testicular cancer by using indocyanine green fluorescence guidance. IJU Case Rep 2021; 4:163-166. [PMID: 33977249 PMCID: PMC8088881 DOI: 10.1002/iju5.12273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION There are few reports on indocyanine green fluorescence-guided surgery in testis-related diseases. CASE PRESENTATION A 38-year-old man underwent orchiectomy for left testicular cancer. Pathological diagnosis was pT1 seminoma. Seven years after the surgery, solitary left external iliac lymph node metastasis was suspected. We decided to perform laparoscopic lymph node dissection combined with indocyanine green fluorescence injection. During the operation, we injected indocyanine green fluorescence into his left inner inguinal ring and found that the lymph node was directly drained from the injection point. The pathological diagnosis of the indocyanine green fluorescence-positive left external iliac lymph node was testicular cancer metastasis. CONCLUSION We experienced a case of solitary left external iliac lymph node recurrence in testicular cancer. Using indocyanine green fluorescence injection, we could visualize the lymphatic drainage route, which helped us identify the lymph node as the primary landing site of metastasis.
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Affiliation(s)
- Yuki Enei
- Department of UrologyThe Jikei University Kashiwa HospitalKashiwaChibaJapan
| | - Fumihiko Urabe
- Department of UrologyThe Jikei University Kashiwa HospitalKashiwaChibaJapan
- Department of UrologyThe Jikei University School of MedicineTokyoJapan
| | - Jun Miki
- Department of UrologyThe Jikei University Kashiwa HospitalKashiwaChibaJapan
- Department of UrologyThe Jikei University School of MedicineTokyoJapan
| | - Kosuke Iwatani
- Department of UrologyThe Jikei University School of MedicineTokyoJapan
| | - Akira Hisakane
- Department of UrologyThe Jikei University School of MedicineTokyoJapan
| | - Keiji Yasue
- Department of UrologyThe Jikei University School of MedicineTokyoJapan
| | - Takafumi Yanagisawa
- Department of UrologyThe Jikei University Kashiwa HospitalKashiwaChibaJapan
- Department of UrologyThe Jikei University School of MedicineTokyoJapan
| | - Takahiro Kimura
- Department of UrologyThe Jikei University School of MedicineTokyoJapan
| | - Shin Egawa
- Department of UrologyThe Jikei University School of MedicineTokyoJapan
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Mihara K, Matsuda S, Nakamura Y, Aiura K, Kuwahata A, Chikaki S, Sekino M, Kusakabe M, Suzuki S, Fuchimoto D, Onishi A, Kuramoto J, Kameyama K, Itano O, Yagi H, Abe Y, Kitago M, Shinoda M, Kitagawa Y. Intraoperative laparoscopic detection of sentinel lymph nodes with indocyanine green and superparamagnetic iron oxide in a swine gallbladder cancer model. PLoS One 2021; 16:e0248531. [PMID: 33705492 PMCID: PMC7951925 DOI: 10.1371/journal.pone.0248531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/27/2021] [Indexed: 12/13/2022] Open
Abstract
Mapping of sentinel lymph nodes (SLNs) can enable less invasive surgery. However, mapping is challenging for cancers of difficult-to-access visceral organs, such as the gallbladder, because the standard method using radioisotopes (RIs) requires preoperative tracer injection. Indocyanine green (ICG) and superparamagnetic iron oxide (SPIO) have also been used as alternative tracers. In this study, we modified a previously reported magnetic probe for laparoscopic use and evaluated the feasibility of detecting SLNs of the gallbladder using a laparoscopic dual tracer method by injecting ICG and SPIO into five swine and one cancer-bearing swine. The laparoscopic probe identified SPIO nanoparticles in the nodes of 4/5 swine in situ, the magnetic field counts were 2.5-15.9 μT, and fluorescence was detected in SLNs in all five swine. ICG showed a visual lymph flow map, and SPIO more accurately identified each SLN with a measurable magnetic field quite similar to the RI. We then developed an advanced gallbladder cancer model with lymph node metastasis using recombination activating gene 2-knockout swine. We identified an SLN in the laparoscopic investigation, and the magnetic field count was 3.5 μT. The SLN was histologically determined to be one of the two metastatic lymph nodes. In conclusion, detecting the SLNs of gallbladder cancer in situ using a dual tracer laparoscopic technique with ICG and SPIO was feasible in a swine model.
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Affiliation(s)
- Kisyo Mihara
- Department of Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki-ku, Kawasaki, Kanagawa, Japan
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Sachiko Matsuda
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuki Nakamura
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Koichi Aiura
- Department of Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki-ku, Kawasaki, Kanagawa, Japan
| | - Akihiro Kuwahata
- Graduate School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shinichi Chikaki
- Graduate School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masaki Sekino
- Graduate School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Moriaki Kusakabe
- Graduate School of Agricultural and Life Sciences, Research Center for Food Safety, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Matrix Cell Research Institute, Inc., Ushiku, Ibaraki, Japan
| | - Shunichi Suzuki
- Division of Animal Sciences, Institute of Agrobiological Sciences, National Agriculture and Food Research Organization (NARO), Tsukuba, Ibaraki, Japan
| | - Daiichiro Fuchimoto
- Division of Animal Sciences, Institute of Agrobiological Sciences, National Agriculture and Food Research Organization (NARO), Tsukuba, Ibaraki, Japan
| | - Akira Onishi
- Laboratory of Animal Reproduction, Department of Animal Science and Resources, College of Bioresource Sciences, Nihon University, Fujisawa, Kanagawa, Japan
| | - Junko Kuramoto
- Department of Pathology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kaori Kameyama
- Department of Diagnostic Pathology, Keio University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Osamu Itano
- Department of Gastrointestinal Surgery, International University of Health and Welfare, Chiba, Japan
| | - Hiroshi Yagi
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Does near-infrared fluorescent cholangiography with indocyanine green reduce bile duct injuries and conversions to open surgery during laparoscopic or robotic cholecystectomy? - A meta-analysis. Surgery 2021; 169:859-867. [PMID: 33478756 DOI: 10.1016/j.surg.2020.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/10/2020] [Accepted: 12/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bile duct injury and conversion-to-open-surgery rates remain unacceptably high during laparoscopic and robotic cholecystectomy. In a recently published randomized clinical trial, using near-infrared fluorescent cholangiography with indocyanine green intraoperatively markedly enhanced biliary-structure visualization. Our systematic literature review compares bile duct injury and conversion-to-open-surgery rates in patients undergoing laparoscopic or robotic cholecystectomy with versus without near-infrared fluorescent cholangiography. METHODS A thorough PubMed search was conducted to identify randomized clinical trials and nonrandomized clinical trials with ≥100 patients. Because all near-infrared fluorescent cholangiography studies were published since 2013, only studies without near-infrared fluorescent cholangiography published since 2013 were included for comparison. Incidence estimates, weighted and unweighted for study size, were adjusted for acute versus chronic cholecystitis, and for robotic versus laparoscopic cholecystectomy and are reported as events/10,000 patients. All studies were assessed for bias risk and high-risk studies excluded. RESULTS In total, 4,990 abstracts were reviewed, identifying 5 near-infrared fluorescent cholangiography studies (3 laparoscopic cholecystectomy/2 robotic cholecystectomy; n = 1,603) and 11 not near-infrared fluorescent cholangiography studies (5 laparoscopic cholecystectomy/4 robotic cholecystectomy/2 both; n = 5,070) for analysis. Overall weighted rates for bile duct injury and conversion were 6 and 16/10,000 in near-infrared fluorescent cholangiography patients versus 25 and 271/10,000 in patients without near-infrared fluorescent cholangiography. Among patients undergoing laparoscopic cholecystectomy, bile duct injuries, and conversion rates among near-infrared fluorescent cholangiography versus patients without near-infrared fluorescent cholangiography were 0 and 23/10,000 versus 32 and 255/10,000, respectively. Bile duct injury rates were low with robotic cholecystectomy with and without near-infrared fluorescent cholangiography (12 and 8/10,000), but there was a marked reduction in conversions with near-infrared fluorescent cholangiography (12 vs 322/10,000). CONCLUSION Although large comparative trials remain necessary, preliminary analysis suggests that using near-infrared fluorescent cholangiography with indocyanine green intraoperatively sizably decreases bile duct injury and conversion-to-open-surgery rates relative to cholecystectomy under white light alone.
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Chen Y, Xiao Q, Zou W, Xia C, Yin H, Pu Y, Wang Y, Zhang K. Sentinel lymph node biopsy in oral cavity cancer using indocyanine green: A systematic review and meta-analysis. Clinics (Sao Paulo) 2021; 76:e2573. [PMID: 34287476 PMCID: PMC8266175 DOI: 10.6061/clinics/2021/e2573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022] Open
Abstract
This meta-analysis was conducted to evaluate the value of indocyanine green (ICG) in guiding sentinel lymph node biopsy (SLNB) for patients with oral cavity cancer. An electronic database search (PubMed, MEDLINE, Cochrane Library, Embase, and Web of Science) was performed from their inception to June 2020 to retrieve clinical studies of ICG applied to SLNB for oral cavity cancer. Data were extracted from 14 relevant articles (226 patients), and 9 studies (134 patients) were finally included in the meta-analysis according to the inclusion and exclusion criteria. The pooled sentinel lymph node (SLN) sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 88.0% (95% confidence interval [CI], 74.0-96.0), 64.0% (95% CI, 61.0-66.0), 2.45 (95% CI, 1.31-4.60), 0.40 (95% CI, 0.17-0.90), and 7.30 (95% CI, 1.74-30.68), respectively. The area under the summary receiver operating characteristic curve was 0.8805. In conclusion, ICG applied to SLNB can effectively predict the status of regional lymph nodes in oral cavity cancer.
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Affiliation(s)
- Yongfeng Chen
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Qi Xiao
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weina Zou
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chengwan Xia
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongling Yin
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yumei Pu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuxin Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
- Corresponding authors. E-mails: /
| | - Kai Zhang
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Corresponding authors. E-mails: /
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Yang C, Cui M, Zhang Y, Pan H, Liu J, Wang S, Ma N, Chang J, Sun T, Wang H. Upconversion optogenetic micro-nanosystem optically controls the secretion of light-responsive bacteria for systemic immunity regulation. Commun Biol 2020; 3:561. [PMID: 33037315 PMCID: PMC7547716 DOI: 10.1038/s42003-020-01287-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/15/2020] [Indexed: 12/17/2022] Open
Abstract
Chemical molecules specifically secreted into the blood and targeted tissues by intestinal microbiota can effectively affect the associated functions of the intestine especially immunity, representing a new strategy for immune-related diseases. However, proper ways of regulating the secretion metabolism of specific strains still remain to be established. In this article, an upconversion optogenetic micro-nanosystem was constructed to effectively regulate the specific secretion of engineered bacteria. The system included two major modules: (i) Modification of secretory light-responsive engineered bacteria. (ii) Optical sensing mediated by upconversion optogenetic micro-nanosystem. This system could regulate the efficient secretion of immune factors by engineered bacteria through optical manipulation. Inflammatory bowel disease and subcutaneously transplanted tumors were selected to verify the effectiveness of the system. Our results showed that the endogenous factor TGF-β1 could be controllably secreted to suppress the intestinal inflammatory response. Additionally, regulatory secretion of IFN-γ was promoted to slow the progression of B16F10 tumor.
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Affiliation(s)
- Chun Yang
- School of Life Sciences, Tianjin University, Tianjin, 300072, China
- Tianjin Engineered Center of Micro-Nano Biomaterials and Detection-Treatment Technology, Tianjin Key Laboratory of Function and Application of Biological Macromolecular Structures, Tianjin, 300072, China
| | - Meihui Cui
- School of Life Sciences, Tianjin University, Tianjin, 300072, China
- Tianjin Engineered Center of Micro-Nano Biomaterials and Detection-Treatment Technology, Tianjin Key Laboratory of Function and Application of Biological Macromolecular Structures, Tianjin, 300072, China
| | - Yingying Zhang
- School of Life Sciences, Tianjin University, Tianjin, 300072, China
- Tianjin Engineered Center of Micro-Nano Biomaterials and Detection-Treatment Technology, Tianjin Key Laboratory of Function and Application of Biological Macromolecular Structures, Tianjin, 300072, China
| | - Huizhuo Pan
- School of Life Sciences, Tianjin University, Tianjin, 300072, China
- Tianjin Engineered Center of Micro-Nano Biomaterials and Detection-Treatment Technology, Tianjin Key Laboratory of Function and Application of Biological Macromolecular Structures, Tianjin, 300072, China
| | - Jing Liu
- School of Life Sciences, Tianjin University, Tianjin, 300072, China
| | - Shixing Wang
- Academy of Medical engineered and Translational Medicine, Tianjin University, Tianjin, 300072, China
| | - Ning Ma
- School of Life Sciences, Tianjin University, Tianjin, 300072, China
- Tianjin Engineered Center of Micro-Nano Biomaterials and Detection-Treatment Technology, Tianjin Key Laboratory of Function and Application of Biological Macromolecular Structures, Tianjin, 300072, China
| | - Jin Chang
- School of Life Sciences, Tianjin University, Tianjin, 300072, China
- Tianjin Engineered Center of Micro-Nano Biomaterials and Detection-Treatment Technology, Tianjin Key Laboratory of Function and Application of Biological Macromolecular Structures, Tianjin, 300072, China
| | - Tao Sun
- Center for Biosafety Research and Strategy, Tianjin University, Tianjin, 300072, China.
- Laboratory of Synthetic Microbiology, School of Chemical engineered and Technology, Tianjin University, Tianjin, 300072, China.
| | - Hanjie Wang
- School of Life Sciences, Tianjin University, Tianjin, 300072, China.
- Tianjin Engineered Center of Micro-Nano Biomaterials and Detection-Treatment Technology, Tianjin Key Laboratory of Function and Application of Biological Macromolecular Structures, Tianjin, 300072, China.
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Sun F, Liu S, Song P, Zhang C, Liu Z, Guan W, Wang M. Impact of retrieved lymph node count on short-term complications in patients with gastric cancer. World J Surg Oncol 2020; 18:224. [PMID: 32838799 PMCID: PMC7446131 DOI: 10.1186/s12957-020-02000-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/12/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is well established that retrieved lymph node (RLN) counts were positively correlated with better overall survival in gastric cancer (GC). But little is known about the relationship between RLN count and short-term complications after radical surgery. METHODS A total of 1487 consecutive GC patients between January 2016 and December 2018 at Nanjing Drum Tower Hospital were retrospectively analyzed. Univariate analyses were performed to elucidate the association between RLN count and postoperative complications. We further identified clinical factors that might affect the RLN count. RESULTS Among all of the patients, postoperative complications occurred in 435 (29.3%) patients. The mean RLN count was 25.1, and 864 (58.1%) patients were diagnosed with lymph node metastasis. Univariate analyses showed no significant difference between RLN count and postoperative complications (both overall and stratified by CDC grade). Univariate and multivariate analyses further revealed that type of resection, tumor invasion, and lymph node metastasis were associated with RLN count. CONCLUSIONS The current study demonstrated that RLN count was not associated with postoperative short-term complications following gastrectomy of GC, which provided a rationale for the determination of a proper RLN count of curative gastrectomy.
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Affiliation(s)
- Feng Sun
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Song Liu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Peng Song
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Chen Zhang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhijian Liu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wenxian Guan
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
| | - Meng Wang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
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Sun WYL, Dang JT, Modasi A, Nasralla A, Switzer NJ, Birch D, Turner SR, Karmali S. Diagnostic accuracy of sentinel lymph node biopsy using indocyanine green in lung cancer: a systematic review and meta-analysis. Gen Thorac Cardiovasc Surg 2020; 68:905-913. [PMID: 32557077 DOI: 10.1007/s11748-020-01400-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/04/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The use of sentinel lymph node biopsy (SLNB) has been gaining popularity with the emergence of indocyanine green (ICG) fluorescence imaging. We aimed to systematically review the literature and perform a meta-analysis on the diagnostic accuracy of SLNB using ICG for lung cancer. METHODS A comprehensive search of MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Library using search terms "lung/pulmonary" AND "tumor/carcinoma/cancer/neoplasm/adenocarcinoma/malignancy/squamous/carcinoid" AND "indocyanine green" was completed in June 2018. Articles were selected based on the following inclusion criteria: (1) diagnostic accuracy study design; (2) ICG injected at the tumor site with near-infrared fluorescence imaging identification of sentinel lymph nodes; (3) lymphadenectomy or sampling was performed as the gold standard. RESULTS Eight primary studies were included with a total of 366 patients. 43.0% of patients were females and the mean tumor size was 2.3 cm. Sentinel lymph nodes were identified with ICG in 251 patients, yielding a pooled identification rate of 0.83 (0.67-0.94). A meta-analysis of seven studies computed a diagnostic odds ratio, sensitivity, and specificity of 177.6 (45.6-691.1), 0.85 (0.71-0.94), and 1.00 (0.98-1.00), respectively. The summary receiver operator characteristic demonstrated an area under the curve of 0.963 (SE = 0.038) and a Q* of 0.91 (SE = 0.057). CONCLUSION Our review found suboptimal results for the diagnostic accuracy of SLNB using ICG and must be improved before routine clinical use. Further research is required to develop a robust protocol for the use SLNB with ICG for lung cancer.
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Affiliation(s)
- Warren Y L Sun
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada.
| | - Jerry T Dang
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada
| | - Aryan Modasi
- Centre for Advancement of Surgical Education and Simulation, Edmonton, AB, Canada
| | - Awrad Nasralla
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada
| | - Noah J Switzer
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation, Edmonton, AB, Canada
| | - Daniel Birch
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation, Edmonton, AB, Canada
| | - Simon R Turner
- Division of Thoracic Surgery, University of Alberta, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation, Edmonton, AB, Canada
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Global updates in the treatment of gastric cancer: a systematic review. Part 2: perioperative management, multimodal therapies, new technologies, standardization of the surgical treatment and educational aspects. Updates Surg 2020; 72:355-378. [PMID: 32306277 DOI: 10.1007/s13304-020-00771-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/11/2020] [Indexed: 12/24/2022]
Abstract
Gastric cancer is the fifth malignancy and the third cause of cancer death worldwide, according to the global cancer statistics presented in 2018. Its definition and staging have been revised in the eight edition of the AJCC/TNM classification, which took effect in 2018. Novel molecular classifications for GC have been recently established and the process of translating these classifications into clinical practice is ongoing. The cornerstone of GC treatment is surgical, in a context of multimodal therapy. Surgical treatment is being standardized, and is evolving according to new anatomical concepts and to the recent technological developments. This is leading to a massive improvement in the use of mini-invasive techniques. Mini-invasive techniques aim to be equivalent to open surgery from an oncologic point of view, with better short-term outcomes. The persecution of better short-term outcomes also includes the optimization of the perioperative management, which is being implemented on large scale according to the enhanced recovery after surgery principles. In the era of precision medicine, multimodal treatment is also evolving. The long-time-awaited results of many trials investigating the role for preoperative and postoperative management have been published, changing the clinical practice. Novel investigations focused both on traditional chemotherapeutic regimens and targeted therapies are currently ongoing. Modern platforms increase the possibility for further standardization of the different treatments, promote the use of big data and open new possibilities for surgical learning. This systematic review in two parts assesses all the current updates in GC treatment.
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Nowak K, Karampinis I, Gerken ALH. Application of Fluorescent Dyes in Visceral Surgery: State of the Art and Future Perspectives. Visc Med 2020; 36:80-87. [PMID: 32355664 DOI: 10.1159/000506910] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background Through the improvement and implementation of advanced intraoperative imaging, the indications for intraoperative fluorescence have spread to various fields of visceral surgery. Indocyanine green (ICG)-based fluorescence angiography and the imaging systems using this certain dye are currently the cornerstone of intraoperative, fluorescence-based medical imaging. Summary The article focuses on principles and approaches of intraoperative fluorescence in general surgery. The current clinical practice of intraoperative fluorescence and its evidence are described. Emerging new fields of application are put in a perspective. Furthermore, the technique and possible pit-falls in the performance of intraoperative ICG fluorescence angiography are described in this review article. Key Messages Overall growing evidence suggests that intraoperative fluorescence imaging delivers valuable additional information to the surgeon, which might help to perform surgery more exactly and reduce perioperative complications. Perfusion assessment can be a helpful tool when performing critical anastomoses. There is evidence from prospective and randomized trials for the benefit of intraoperative ICG fluorescence angiography during esophageal reconstruction, colorectal surgery, and surgery for mesenteric ischemia. Most studies suggest the administration of 2.5-10 mg of ICG. Standardized settings and documentation are essential. The benefit of ICG fluorescence imaging for gastrointestinal sentinel node detection and detection of liver tumors and colorectal metastases of the liver cannot clearly be estimated duo to the small number of prospective studies. Critical points in the use of intraoperative fluorescence imaging remain the low standardization and reproducibility of the results and the associated difficulty in comparing the results of the existing trials. Furthermore, little is known about the influence of hemodynamic parameters on the quantitative assessment of ICG fluorescence during surgery.
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Affiliation(s)
- Kai Nowak
- Department of Surgery, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Ioannis Karampinis
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Mannheim, Germany
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Barchi LC, Souza WP, Franciss MY, Ramos MFKP, Dias AR, Hyung WJ, Zilberstein B. Oncological Robot-Assisted Gastrectomy: Technical Aspects and Ongoing Data. J Laparoendosc Adv Surg Tech A 2020; 30:127-139. [PMID: 31219395 DOI: 10.1089/lap.2019.0345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Robotic surgery through the da Vinci Surgical System has been widely spread for many procedures across the globe for several years. At the same time, robot-assisted gastrectomy for gastric cancer (GC) remains mostly available only in specialized centers in minimally invasive surgery and stomach neoplasm. The robotic platform has been introduced to overcome possible drawbacks of the laparoscopic approach. The safety and the feasibility of robotic radical gastrectomy have been reported in many retrospective case series and nonrandomized prospective studies. However, the superiority of robotic gastrectomy over the laparoscopic access has not yet been proven. This study aimed to report the technical aspects of robot-assisted gastrectomy for GC as well as the latest evidence on this subject.
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Affiliation(s)
- Leandro Cardoso Barchi
- Department of Digestive Surgery, Gastromed Institute, São Paulo, Brazil
- Digestive Surgery Division, Department of Gastroenterology, Medical School, University of São Paulo, São Paulo, Brazil
- Department of Digestive Surgery, Faculty of Medicine São Leopold Mandic, Campinas, Brazil
| | - Willy Petrini Souza
- Department of Digestive Surgery, Gastromed Institute, São Paulo, Brazil
- Department of Digestive Surgery, Faculty of Medicine São Leopold Mandic, Campinas, Brazil
| | - Maurice Youssef Franciss
- Department of Digestive Surgery, Gastromed Institute, São Paulo, Brazil
- Department of Digestive Surgery, Faculty of Medicine São Leopold Mandic, Campinas, Brazil
| | | | - Andre Roncon Dias
- Digestive Surgery Division, Department of Gastroenterology, Medical School, University of São Paulo, São Paulo, Brazil
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Bruno Zilberstein
- Department of Digestive Surgery, Gastromed Institute, São Paulo, Brazil
- Digestive Surgery Division, Department of Gastroenterology, Medical School, University of São Paulo, São Paulo, Brazil
- Department of Digestive Surgery, Faculty of Medicine São Leopold Mandic, Campinas, Brazil
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Sentinel lymph node detection for gastric cancer: Promise or pitfall? Surg Oncol 2019; 33:1-6. [PMID: 31885358 DOI: 10.1016/j.suronc.2019.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/24/2019] [Accepted: 12/18/2019] [Indexed: 12/15/2022]
Abstract
At present, optimal surgery for gastric cancer is still under debate, especially the extent of lymph node dissection. Gastrectomy with D1/D2 lymphadenectomy is standard treatment for resectable advanced gastric cancer. However, in early gastric cancer without lymph node metastasis, gastrectomy with D1/D2 lymphadenectomy may not be unnecessary, which could increases morbidity and mortality and reduces the quality of life (QOL). Therefore, the concept of sentinel lymph node could be applied in gastric cancer. But due to the complexity of gastric lymphatic drainage, there are still many issues under debate, such as suitable tracers, the method of mapping and collecting and the oncologic safety of sentinel node navigation surgery (SNNS). In addition, skip metastasis and unreliability of intraoperative pathological diagnosis are two main reasons for false negative cases. In this review, we summarize the current status and controversy of sentinel lymph node detection in gastric cancer, attempting to help with practical application. Further, we hold opinion that we should be cautious about performing sentinel lymph node detection in gastric cancer before an accurate and effective method occurs.
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Detection of the sentinel node in pancreatic cancer by fluorescence imaging. Cir Esp 2019; 98:301-303. [PMID: 31635823 DOI: 10.1016/j.ciresp.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/20/2019] [Accepted: 08/22/2019] [Indexed: 12/27/2022]
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