Near-infrared image-guided lymphatic mapping in minimally invasive oesophagectomy of distal oesophageal cancer.

OBJECTIVES

We aimed to assess the potential of near-infrared (NIR) imaging during minimally invasive oesophagectomy in patients with distal oesophageal cancer for detection of nodal metastases inside and outside the standard en bloc surgical field.

METHODS

We enrolled 6 patients diagnosed with distal oesophageal cancer for intraoperative lymphatic mapping with NIR imaging. Indocyanine green dye was injected endoscopically in 8 corners of the primary tumour at the start of the operation. The minimally invasive oesophagectomy with en bloc lymphadenectomy was performed using 3D optics. A separate endoscopic fluorescence imaging system was used to systematically detect the NIR signal of 23 lymphatic stations. The NIR-positive stations outside the en bloc resection area were also removed for histological analysis.

RESULTS

Lymphatic mapping was successful in all patients. The NIR-positive areas were most commonly detected in the lower mediastinum (100% of patients), cardia (83%), region of the left gastric artery (67%), celiac axis (50%) and pericardial-diaphragmatic groove (50%). We detected NIR-positive areas outside the traditional en bloc field above the azygous arch in 50% of the patients. A total of 182 lymph nodes were resected from 6 patients. In 3 patients, a total of 19 lymph node metastases were detected, 4 of which were outside the en bloc field.

CONCLUSIONS

NIR imaging can be useful for detecting lymphatic stations that most likely present with metastatic disease and to guide the tailored extension of the traditional lymphadenectomy.