First experience of fluorescence-guided lymph node dessection for gastric cancer
DOI:
https://doi.org/10.11603/2414-4533.2019.1.9916Keywords:
indocyanine green, fluorescence lymphography, D2 lymph node dissection, gastric cancerAbstract
The aim of the work: evaluation of results of the first experience in use of fluorescence-guided D2 lymph node dissection lymph for gastric cancer.
Materials and Methods. Fluorescence lymphography was performed in two patients. The first patient with cancer of upper third of stomach without involvement of cardia, with regional lymphadenopathy, underwent gastrectomy with D2 lymph node dissection. There was no postoperative complications. Tube feeding started from the 5th day. Intestinal tube was extracted and enteral feeding started on the 10th day. The patient was discharged on the 12th day. A second patient with an infiltrative tumor of antral part and stenosis of pylorus, with regional lymphadenopathy, underwent subtotal gastrectomy with D2 lymph node dissection. External pancreatic fistula evolved postoperatively and closed on the 14 day. The intestinal tube was removed on the 10th day. The patient was discharged on the 15th day. In both cases, at the beginning of procedure, 10 ml of indocyanine green were injected around the tumor. A special system by KarlStorz with exoscope optics Vitom II was used.
Results and Discussion. In both cases, after 50–60 minutes post injection, examination in near-infrared light showed fluorescence of the primary tumor and bright fluorescence of the regional lymph nodes, with more active fluorescence observed in the lymph nodes belonging to the main lymph flow basin. Also, the fluorescence allowed visualizing the lymph nodes in the thickness of adipose tissue, which could not be determined, and allowed to control their absence on completion of systematic lymph node dissection. After completion of dissection, no fluorescence of lymph nodes was observed. Thus, fluorescence allowed to check the completeness of lymph node dissection.
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