Copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Application of indocyanine green-enhanced near-infrared fluorescence-guided imaging in laparoscopic lateral pelvic lymph node dissection for middle-low rectal cancer
Si-Cheng Zhou, Yan-Tao Tian, Xue-Wei Wang, Chuan-Duo Zhao, Shuai Ma, Jun Jiang, Er-Ni Li, Hai-Tao Zhou, Qian Liu, Jian-Wei Liang, Zhi-Xiang Zhou, Xi-Shan Wang
Si-Cheng Zhou, Xue-Wei Wang, Chuan-Duo Zhao, Hai-Tao Zhou, Qian Liu, Jian-Wei Liang, Zhi-Xiang Zhou, Xi-Shan Wang, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Yan-Tao Tian, Shuai Ma, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Jun Jiang, Er-Ni Li, Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Zhou SC and Tian YT contributed equally to this work; Zhou SC, Tian YT, Wang XW, Ma S, Zhou HT, and Liang JW designed and performed the research; Zhou SC, Jiang J, Li EN, and Zhao CD collected and analyzed the data; Zhou SC and Tian YT wrote the paper; Liu Q, Liang JW, Zhou ZX, and Wang XS revised the paper.
Institutional review board statement: The study was reviewed and approved by the ethics committee of National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: There are no conflict of interests to declare.
Data sharing statement: No additional data are available.
STROBE statement: This study complied with the items listed in the STROBE guidelines.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian-Wei Liang, MD, Professor, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. liangjw1976@126.com
Telephone: +86-10-87787110 Fax: +86-10-87787110
Received: May 26, 2019
Peer-review started: May 27, 2019
First decision: June 16, 2019
Revised: July 8, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: August 21, 2019
ARTICLE HIGHLIGHTS
Research background
Recently, ICG fluorescence-guided imaging has been applied to guide sentinel lymph node detection in various malignant tumours. As an effective treatment for lateral pelvic lymph node (LPLN) metastasis (LPNM), laparoscopic LPLN dissection (LPND) is limited due to the complicated anatomy of the pelvic sidewall and various complications after surgery. With regard to improving the accuracy and completeness of LPND as well as in terms of safety, we tried an innovative method using ICG visualized with a near-infrared camera (NIR) system to guide the detection of LPLNs in patients with middle-low rectal cancer.
Research motivation
The purpose of this study was to compare and analyse the clinical and pathological outcomes of LPND via an ICG-enhanced NIR fluorescence-guided imaging procedure vs a traditional procedure. The significance of this study is that it introduces a more effective and safe method for rectal cancer patients who undergo LPND.
Research objectives
The study aimed to evaluate the safety and availability of LPND via ICG-enhanced NIR fluorescence-guided imaging in patients with rectal cancer.
Research methods
Middle-low rectal cancer patients who underwent total mesorectal excision (TME) and LPND were systemically reviewed between October 2017 and March 2019 at our institution. Clinical characteristics, operative outcomes, pathological outcomes, and postoperative complication information were collected and analysed using SPSS version 24.0 between the two groups.
Research results
The results showed that intraoperative blood loss was significantly lower in the ICG group than in the non-ICG group (P = 0.003). Compared to the non-ICG group, the ICG group had a significantly larger number of LPLNs harvested (11.5 ± 5.9 vs 7.1 ± 4.8, P = 0.017). In addition, no significant difference was found in terms of LPND, LPNM, operative time, conversion to laparotomy, preoperative complication, or hospital stay (P > 0.05).
Research conclusions
ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could increase the number of LPLNs harvested and bring specific advantages regarding the accuracy and completeness of surgery as well as safety.
Research perspectives
In this study, we emphasized that the location and concentration of ICG injection are critical for surgical outcome. Moreover, this is a retrospective study with a small sample size, and bias may exist. Further randomized prospective controlled trials are needed to confirm our results.
