Surgery today · 2026
Investigation of the regional lymph nodes in left-sided pancreas tumors by intraoperative identification using indocyanine green fluorescence imaging.
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Futagawa Yasuro, Abe Kyohei, Kawai Hironari, Matsumoto Michinori, Yasuda Jungo, Sakamoto Taro, Okamoto Tomoyoshi, Ikegami Toru
Аннотация
PURPOSE: To identify the regional lymph nodes (LNs) in patients with left-sided pancreatic tumors using intraoperative indocyanine green fluorescence imaging (ICGFI).
METHODS: The lymphatic flow was evaluated using the ICGFI in 15 patients with left-sided pancreatic tumors. Indocyanine green was administered locally, near the tumor, intraoperatively.
RESULTS: The distribution of ICGFI-positive lymph node stations differed according to the distance between the left side of the portal vein and the right side of the tumor (DPT). Patients with a DPT ≤ 71 mm (Group A, n = 10) and those with a DPT ≥ 72 mm (Group B, n = 5) showed different lymphatic drainage patterns. In Group A, the frequencies of positive LN stations detected by ICGFI were as follows: stations 7, 8, 9, 11, 14, and 18 had rates of 20%, 70%, 30%, 60%, 70%, and 20%, respectively. In contrast, in Group B, stations 10, 11, and 14 had rates of 40%, 80%, and 20%, respectively, with no observations at stations 7, 8, and 9. A statistically significant difference was observed between the two groups at station 8 (70% vs. 0%; p = 0.03).
CONCLUSIONS: ICGFI may provide useful anatomical insights into the lymphatic drainage pathways of left-sided pancreatic tumors and serve as a basis for future studies evaluating tailored lymphadenectomy strategies.
METHODS: The lymphatic flow was evaluated using the ICGFI in 15 patients with left-sided pancreatic tumors. Indocyanine green was administered locally, near the tumor, intraoperatively.
RESULTS: The distribution of ICGFI-positive lymph node stations differed according to the distance between the left side of the portal vein and the right side of the tumor (DPT). Patients with a DPT ≤ 71 mm (Group A, n = 10) and those with a DPT ≥ 72 mm (Group B, n = 5) showed different lymphatic drainage patterns. In Group A, the frequencies of positive LN stations detected by ICGFI were as follows: stations 7, 8, 9, 11, 14, and 18 had rates of 20%, 70%, 30%, 60%, 70%, and 20%, respectively. In contrast, in Group B, stations 10, 11, and 14 had rates of 40%, 80%, and 20%, respectively, with no observations at stations 7, 8, and 9. A statistically significant difference was observed between the two groups at station 8 (70% vs. 0%; p = 0.03).
CONCLUSIONS: ICGFI may provide useful anatomical insights into the lymphatic drainage pathways of left-sided pancreatic tumors and serve as a basis for future studies evaluating tailored lymphadenectomy strategies.