Quantitative imaging in medicine and surgery · 2025
Perioperative outcomes and survival of indocyanine green-guided minimally esophagectomy in patients with esophageal cancer: a retrospective comparison study.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Shen Xiaokang, Cai Yuchen, Xu Zhiyun, Yu Pengcheng, Bhatti Muhammad Zunair, Chen Shilin, Zhan Chuanfei, Chen Tianming, Zhu Hongyu, Zheng Lin
Аннотация
BACKGROUND: A growing body of clinical research has highlighted the potential of intraoperative fluorescence imaging for precise lymph node (LN) identification and dissection in esophageal cancer (EC). However, several issues remain. This study aimed to evaluate the safety and feasibility of indocyanine green (ICG)-guided LN dissection during radical esophagectomy in patients with esophageal squamous cell carcinoma (ESCC), while also assessing its long-term outcomes. Our findings provide a theoretical foundation for future research in this field.
METHODS: This retrospective cohort study included patients with ESCC who underwent surgical resection at a single center between November 2019 and November 2021. Univariable and multivariable Cox proportional hazard models were used to identify the prognostic factors associated with disease-free survival (DFS) and overall survival (OS). Data, including baseline patient characteristics, postoperative complications, quality of life scores, and survival outcomes, were collected through a comprehensive review of the clinical record system and patient-administered surveys.
RESULTS: The two groups were well-balanced in terms of the baseline characteristics [all P>0.05, except American Society of Anesthesiologists (ASA) classification, P=0.023]. Compared with the non-ICG group, the ICG group had significantly higher mean numbers of pathologically dissected LNs (15.1±1.6 vs. 12.5±3.0, P<0.001) and small mediastinal lymph nodes (smLNs) (6.2±1.8 vs. 3.1±1.2, P<0.001). The number of metastatic smLNs was also significantly higher in the ICG group than the non-ICG group (2.3±1.1 vs. 1.2±0.8, P<0.05), while the number of LN stations dissected was comparable between the two groups (P=0.995). No significant differences were observed between the two groups in terms of the postoperative complications (e.g., anastomotic fistula: 10.0% vs. 6.9%, P=0.559; chylothorax: 6.7% vs. 14.7%, P=0.121) and operative metrics (total operative time: 245.3±32.6 vs. 238.5±29.4 min, P=0.215; intraoperative blood loss: 125.6±35.2 vs. 132.3±38.7 mL, P=0.324). In the survival analysis, the ICG group had significantly better DFS (median follow-up: 30.1 vs. 28.7 months) and OS (median follow-up: 32.7 vs. 29.9 months) than the non-ICG group. The non-ICG group had higher event rates for DFS (64.7% vs. 41.7%) and OS (38.8% vs. 28.3%), with multivariable-adjusted hazard ratios (HRs) of 3.38 [95% confidence interval (CI): 1.99-5.74, P<0.001] for DFS and 2.86 (95% CI: 1.51-5.43, P<0.001) for OS. Additionally, the ICG group had a significantly lower locoregional recurrence rate than the non-ICG group (48.0% vs. 65.3%, P=0.042).
CONCLUSIONS: ICG-guided LN dissection during minimally invasive EC surgery may contribute to improved DFS and OS in patients with ESCC.
METHODS: This retrospective cohort study included patients with ESCC who underwent surgical resection at a single center between November 2019 and November 2021. Univariable and multivariable Cox proportional hazard models were used to identify the prognostic factors associated with disease-free survival (DFS) and overall survival (OS). Data, including baseline patient characteristics, postoperative complications, quality of life scores, and survival outcomes, were collected through a comprehensive review of the clinical record system and patient-administered surveys.
RESULTS: The two groups were well-balanced in terms of the baseline characteristics [all P>0.05, except American Society of Anesthesiologists (ASA) classification, P=0.023]. Compared with the non-ICG group, the ICG group had significantly higher mean numbers of pathologically dissected LNs (15.1±1.6 vs. 12.5±3.0, P<0.001) and small mediastinal lymph nodes (smLNs) (6.2±1.8 vs. 3.1±1.2, P<0.001). The number of metastatic smLNs was also significantly higher in the ICG group than the non-ICG group (2.3±1.1 vs. 1.2±0.8, P<0.05), while the number of LN stations dissected was comparable between the two groups (P=0.995). No significant differences were observed between the two groups in terms of the postoperative complications (e.g., anastomotic fistula: 10.0% vs. 6.9%, P=0.559; chylothorax: 6.7% vs. 14.7%, P=0.121) and operative metrics (total operative time: 245.3±32.6 vs. 238.5±29.4 min, P=0.215; intraoperative blood loss: 125.6±35.2 vs. 132.3±38.7 mL, P=0.324). In the survival analysis, the ICG group had significantly better DFS (median follow-up: 30.1 vs. 28.7 months) and OS (median follow-up: 32.7 vs. 29.9 months) than the non-ICG group. The non-ICG group had higher event rates for DFS (64.7% vs. 41.7%) and OS (38.8% vs. 28.3%), with multivariable-adjusted hazard ratios (HRs) of 3.38 [95% confidence interval (CI): 1.99-5.74, P<0.001] for DFS and 2.86 (95% CI: 1.51-5.43, P<0.001) for OS. Additionally, the ICG group had a significantly lower locoregional recurrence rate than the non-ICG group (48.0% vs. 65.3%, P=0.042).
CONCLUSIONS: ICG-guided LN dissection during minimally invasive EC surgery may contribute to improved DFS and OS in patients with ESCC.