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Sakamoto E, Safatle-Ribeiro AV, Jr UR, Ribeiro Jr U. Advances in surgical techniques for gastric cancer: Indocyanine green and near-infrared fluorescence imaging. Is it ready for prime time? Chin J Cancer Res 2022; 34:587-591. [PMID: 36714345 PMCID: PMC9829491 DOI: 10.21147/j.issn.1000-9604.2022.06.06] [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: 11/12/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
Surgery is still the primary curative treatment for gastric cancer, which includes resection of the tumor with adequate margins and extended lymphadenectomy. In order to improve the operative results and the quality of life of patients, several endeavors have been made toward precision medicine through image-guided surgery, allowing access to real-time intraoperative anatomy and accurate tumor staging. The goal of the surgeon is to achieve a more precise, individualized, and less invasive surgery without compromising oncological efficiency and safety. In this perspective, we have demonstrated the role of indocyanine green (ICG) and near-infrared (NIR) fluorescence imaging method in gastric cancer surgery. This technique may be used to improve localization of the tumor, detection of sentinel lymph nodes (SLN), real-time lymphatic mapping, and blood flow assessment (anastomosis perfusion).
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Affiliation(s)
- Erica Sakamoto
- Department of Gastroenterology, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, (ICESP-HCFMUSP) São Paulo, SP 01246-000, Brazil
| | - Adriana Vaz Safatle-Ribeiro
- Department of Gastroenterology, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, (ICESP-HCFMUSP) São Paulo, SP 01246-000, Brazil
| | - Ulysses Ribeiro Jr
- Department of Gastroenterology, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, (ICESP-HCFMUSP) São Paulo, SP 01246-000, Brazil,Ulysses Ribeiro Jr. Department of Gastroenterology, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, (ICESP-HCFMUSP) São Paulo, SP 01246-000, Brazil.
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Sakamoto E, Kodama Pertille Ramos MF, Dias AR, Safatle-Ribeiro AV, Zilberstein B, Nahas SC, Junior UR. Indocyanine green imaging to guide lymphadenectomy in laparoscopic distal gastrectomy - With vídeo. Ann Med Surg (Lond) 2021; 69:102657. [PMID: 34408870 PMCID: PMC8361283 DOI: 10.1016/j.amsu.2021.102657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 10/25/2022] Open
Abstract
Gastric cancer (GC) is one of the most lethal malignancies and Gastrectomy with D2 lymphadenectomy is considered the standard surgical treatment. Adequate lymph node dissection is necessary for patients' prognosis, but D2 lymphadenectomy is technically demanding due to the complexity of anatomy, even more so if performed laparoscopically. The learning curve requires a high degree of training with a considerable number of cases and standardization of the technique. Recently, Indocyanine Green (ICG) and Near-Infrared (NIR) Fluorescence Imaging have been presented as promising image-guided surgery techniques, providing real-time anatomy assessment and intra-operative visualization of blood flow, lymph nodes and lymphatic vessels. ICG fluorescence imaging has been studied in GC surgery, especially for real-time lymphatic mapping. At present, we are conducting a prospective, open-label, single-arm clinical trial (Clinical trial - NCT03021200) to evaluate the feasibility and outcomes of ICG and NIR Fluorescence Imaging in GC surgery. In this technical note, we present one approach to the use of this technique to guide lymphadenectomy in laparoscopic distal gastrectomy.
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Affiliation(s)
- Erica Sakamoto
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto Do Câncer Do Estado de São Paulo, Hospital Das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Marcus Fernando Kodama Pertille Ramos
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto Do Câncer Do Estado de São Paulo, Hospital Das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Andre Roncon Dias
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto Do Câncer Do Estado de São Paulo, Hospital Das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Adriana Vaz Safatle-Ribeiro
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto Do Câncer Do Estado de São Paulo, Hospital Das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Bruno Zilberstein
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto Do Câncer Do Estado de São Paulo, Hospital Das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Sergio Carlos Nahas
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto Do Câncer Do Estado de São Paulo, Hospital Das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Ulysses Ribeiro Junior
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto Do Câncer Do Estado de São Paulo, Hospital Das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
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