Fluorescent Lymphography-Guided Lymphadenectomy during Minimally Invasive Completion Total Gastrectomy for Remnant Gastric Cancer Patients
Abstract
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Endoscopic Injection of ICG
2.3. Surgical Procedures Including Fluorescent Lymphography-Guided Lymphadenectomy
2.4. Lymph Node Retrieval and Examination
2.5. Statistical Analysis
3. Results
- Comparison of perioperative outcomes;
- Comparison of lymph node retrieval;
- Diagnostic accuracy of fluorescent lymphography-guided lymphadenectomy;
- Comparison of survival.
3.1. Comparison of Perioperative Outcomes
3.2. Comparison of Lymph Node Retrieval
3.3. Diagnostic Accuracy of Fluorescent Lymphography-Guided Lymphadenectomy
3.4. Comparison of Survival
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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FL Group (n = 32) | Non-FL Group (n = 36) | p-Value | |
---|---|---|---|
Age (years), mean (SD) | 62.5 (14.7) | 59.9 (14.1) | 0.452 |
Sex | 0.265 | ||
Male | 21 (65.6) | 28 (77.8) | |
Female | 11 (34.4) | 8 (22.2) | |
BMI (kg/m2), median (IQR) | 21.9 (6.3) | 21.4 (3.9) | 0.636 |
ASA classification | 0.622 | ||
I | 2 (6.3) | 6 (16.7) | |
II | 17 (53.1) | 17 (47.2) | |
III | 11 (34.4) | 11 (30.6) | |
IV | 2 (6.3) | 2 (5.6) | |
Prior gastrectomy | 0.890 | ||
STG with BI | 10 (31.3) | 11 (30.6) | |
STG with BII | 21 (65.6) | 25 (69.4) | |
STG with RY GJ | 1 (3.1) | 0 | |
Operation method of prior gastrectomy | 0.226 | ||
Open | 13 (40.6) | 18 (50.0) | |
Laparoscopy | 9 (28.1) | 13 (36.1) | |
Robot | 10 (31.3) | 5 (13.9) | |
Cause of prior gastrectomy | 0.245 | ||
Cancer | 24 (75.0) | 31 (86.1) | |
Peptic ulcer | 8 (25.0) | 5 (13.9) | |
Clinical T classification † | 0.829 | ||
T1 | 25 (78.1) | 31 (86.1) | |
T2 | 4 (12.5) | 3 (8.3) | |
T3 | 2 (6.3) | 1 (2.8) | |
T4 | 1 (3.1) | 1 (2.8) | |
Clinical N classification † | 0.660 | ||
N0 | 29 (90.6) | 34 (94.4) | |
N+ | 3 (9.4) | 2 (5.6) | |
Tumor size (mm), mean (SD) | 35.7 (19.5) | 31.2 (18.9) | 0.338 |
Pathologic T stage † | 0.754 | ||
T1 | 21(65.6) | 20(55.6) | |
T2 | 4(12.5) | 5(13.9) | |
T3 | 2(6.3) | 5 (13.9) | |
T4a | 5(15.6) | 6(16.7) | |
Pathologic N stage † | 0.541 | ||
N0 | 28 (87.5) | 28 (77.8) | |
N1 | 3 (9.4) | 3 (8.3) | |
N2 | 1 (3.1) | 2 (5.6) | |
N3 | 0 | 3 (8.3) |
FL Group (n = 32) | Non-FL Group (n = 36) | p-Value | |
---|---|---|---|
Operation method | 0.001 | ||
Laparoscopy | 12 (37.5) | 28 (77.8) | |
Robot | 20 (62.5) | 8 (22.2) | |
Combined resection | 0.660 | ||
No | 29(90.6) | 34 (94.4) | |
Yes | 3 (9.4) | 2 (5.6) | |
Operation time (minutes), mean (SD) | 273.8 (77.0) | 252.0 (58.2) | 0.190 |
Estimated blood loss (mL), median (IQR) | 100 (52–154) | 115 (85–211) | 0.224 |
Postoperative complications | 0.392 | ||
Absent | 12 (37.5) | 10 (27.8) | |
Present | 20 (62.5) | 26 (72.2) | |
Clavien–Dindo Classification | 0.466 | ||
Grade I | 8 (40.0) | 6 (23.1) | |
Grade II | 9 (45.0) | 16 (61.5) | |
≥Grade IIIa | 3 (15.0) | 4 (15.4) | |
Postoperative mortality | 0 | 0 | 0 |
Hospital stays (days), median (IQR) | 6 (5–10.5) | 7.5 (6–15) | 0.099 |
Patients | FL Group (n = 32) | Non-FL Group (n = 36) | p-Value |
---|---|---|---|
Number of retrieved LN, median (IQR) | 17 (9.3–23.5) | 12.5 (4–17.8) | 0.016 |
Number of retrieved LN in the patients who underwent prior gastrectomy due to cancer, median (IQR) | 15 (7.3–18) (n = 24) | 11 (4–15) (n = 31) | 0.056 |
Number of retrieved LN in the patients who underwent prior gastrectomy due to peptic ulcer, median (IQR) | 28.5 (21–52.3) (n = 8) | 19 (17.5–24) (n = 5) | 0.067 |
Number of cases that show total retrieved lymph nodes ≥ 16 (percentage) | 19 (59.4%) | 12 (33.3%) | 0.031 |
Total retrieved lymph nodes <16 and metastatic lymph nodes ≥1 (percentage) | 0 | 6 (16.7%) | 0.026 |
Total Number | Number of Metastasis | Number of Non-Metastasis | Sensitivity (%) | Specificity (%) | Positive Predictive Value (%) | Negative Predictive Value (%) | |
---|---|---|---|---|---|---|---|
Total LN stations | 146 | ||||||
Fluorescent station | 114 | 3 | 111 | 75 | 21.8 | 2.6 | 96.9 |
Non-fluorescent station | 32 | 1 | 31 | ||||
Total LNs | 630 | ||||||
Fluorescent LNs | 455 | 4 | 451 | 44.4 | 27.4 | 0.9 | 97.1 |
Non-fluorescent LNs | 175 | 5 | 170 |
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Alrashidi, N.; Kim, K.-Y.; Park, S.H.; Lee, S.; Cho, M.; Kim, Y.M.; Kim, H.-I.; Hyung, W.J. Fluorescent Lymphography-Guided Lymphadenectomy during Minimally Invasive Completion Total Gastrectomy for Remnant Gastric Cancer Patients. Cancers 2022, 14, 5037. https://doi.org/10.3390/cancers14205037
Alrashidi N, Kim K-Y, Park SH, Lee S, Cho M, Kim YM, Kim H-I, Hyung WJ. Fluorescent Lymphography-Guided Lymphadenectomy during Minimally Invasive Completion Total Gastrectomy for Remnant Gastric Cancer Patients. Cancers. 2022; 14(20):5037. https://doi.org/10.3390/cancers14205037
Chicago/Turabian StyleAlrashidi, Nasser, Ki-Yoon Kim, Sung Hyun Park, Sejin Lee, Minah Cho, Yoo Min Kim, Hyoung-Il Kim, and Woo Jin Hyung. 2022. "Fluorescent Lymphography-Guided Lymphadenectomy during Minimally Invasive Completion Total Gastrectomy for Remnant Gastric Cancer Patients" Cancers 14, no. 20: 5037. https://doi.org/10.3390/cancers14205037
APA StyleAlrashidi, N., Kim, K.-Y., Park, S. H., Lee, S., Cho, M., Kim, Y. M., Kim, H.-I., & Hyung, W. J. (2022). Fluorescent Lymphography-Guided Lymphadenectomy during Minimally Invasive Completion Total Gastrectomy for Remnant Gastric Cancer Patients. Cancers, 14(20), 5037. https://doi.org/10.3390/cancers14205037