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13.10.2022 | Research

Safety and efficacy of preoperative indocyanine green fluorescence marking in laparoscopic gastrectomy for proximal gastric and esophagogastric junction adenocarcinoma (ICG MAP study)

verfasst von: Takeshi Omori, Hisashi Hara, Naoki Shinno, Masaaki Yamamoto, Takashi Kanemura, Tomohira Takeoka, Hirofumi Akita, Hiroshi Wada, Masayoshi Yasui, Chu Matsuda, Junichi Nishimura, Masayuki Ohue, Masato Sakon, Hiroshi Miyata

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 8/2022

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Abstract

Purpose

The incidence of adenocarcinoma of the esophagogastric junction (AEG) and proximal gastric cancer (PGC) is rising worldwide. Recently, the use of indocyanine green (ICG) tracer-guided surgery has been reported; however, its efficacy for total/proximal gastrectomy has not been clarified. We evaluated the feasibility and safety of ICG fluorescent marking for tumor localization in AEG/PGC treatment by laparoscopic surgery.

Methods

We enrolled patients with AEG/PGC from October 2016 to March 2019 from a prospectively registered database. On the day before surgery, ICG markings were made at four locations just at the edge of the tumor by gastrointestinal fiberscope examination. Surgery was performed while viewing the fluorescence image of ICG, and the proximal portions of the esophagus and the distal portion of the stomach were resected at the edge of the area where ICG had spread.

Results

We enrolled 130 patients with AEG/PGC. Overall, 107 patients were eventually included in the study: AEG n = 64 (60%) and PGC n = 43 (40%). ICG markings were detected intraoperatively in all cases, and cancer invasion into the resection lines of the esophagus and stomach, performed based on ICG fluorescence images, was negative in all cases. The median visible range of ICG fluorescence was 22.5 mm. ICG diffusion expanded 20 mm proximal for AEG. There were no adverse events associated with endoscopic ICG injection.

Conclusion

ICG fluorescence imaging is feasible and safe and can potentially be used as a tumor-marking agent for determining the surgical resection line for total/proximal gastrectomy in AEG and PGC treatment.

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Titel: Safety and efficacy of preoperative indocyanine green fluorescence marking in laparoscopic gastrectomy for proximal gastric and esophagogastric junction adenocarcinoma (ICG MAP study)
verfasst von: Takeshi Omori
Hisashi Hara
Naoki Shinno
Masaaki Yamamoto
Takashi Kanemura
Tomohira Takeoka
Hirofumi Akita
Hiroshi Wada
Masayoshi Yasui
Chu Matsuda
Junichi Nishimura
Masayuki Ohue
Masato Sakon
Hiroshi Miyata
Publikationsdatum: 13.10.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Langenbeck's Archives of Surgery / Ausgabe 8/2022
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-022-02680-9

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Safety and efficacy of preoperative indocyanine green fluorescence marking in laparoscopic gastrectomy for proximal gastric and esophagogastric junction adenocarcinoma (ICG MAP study)