Surgery · 2026
Near infrared fluorescence-guided lymphadenectomy during esophagectomy for esophageal squamous cell carcinoma.
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Singh Sanjamjot, Varshney Vaibhav Kumar, Rai Ankit, Selvakumar B, Varshney Peeyush, Agarwal Lokesh, Soni Subhash, Lal Birda Chhagan, Agarwal Ashish
Аннотация
BACKGROUND: Lymph node metastasis is a crucial prognostic factor for esophageal squamous cell carcinoma. This study evaluated the role of near-infrared fluorescence imaging-guided lymphadenectomy during minimally invasive esophagectomy after a peritumoral indocyanine green injection.
METHODS: A prospective cohort of 30 patients with esophageal squamous cell carcinoma who underwent minimally invasive esophagectomy with 2-field lymphadenectomy between January 2023 and December 2024 was evaluated. Preoperatively, indocyanine green dye (0.5 mL, 2.5 mg) was injected peritumoral in 4 quadrants. During lymphadenectomy, all indocyanine green-positive and -negative lymph nodes were retrieved and documented station-wise. On histopathology, the total number of lymph nodes retrieved was recorded, and indocyanine green positivity was correlated with histopathologic positivity as the primary endpoint.
RESULTS: The median age of the cohort was 51 years (interquartile range: 45-61 years). The commonest location of esophageal squamous cell carcinoma was lower thoracic (14 of 30, 47%), and all patients received neoadjuvant chemoradiotherapy, followed by minimally invasive esophagectomy. A total of 678 lymph nodes were retrieved, with a median of 23.5 lymph nodes per patient (interquartile range: 9-40). Overall, 56 of 678 lymph nodes (8.3%) were indocyanine green positive, of which 16 (28.6%) were positive for malignancy on histopathology. Among the 678 lymph nodes harvested, 20 (2.9%) were positive on histopathology, with 80% (16 of 20) being indocyanine green fluorescence positive. The indocyanine green positivity in lymph nodes had an 80% sensitivity, a 93% specificity, a 28.3% positive predictive value, and a 99.4% negative predictive value for accurately detecting histopathology-positive lymph nodes.
CONCLUSION: Esophagectomy with indocyanine green fluorescence-guided lymphadenectomy can serve as a complementary mapping tool to enhance the clearance of histopathology-positive lymph nodes. Indocyanine green-negative nodes showed a high negative predictive value but do not replace standard anatomic lymphadenectomy.
METHODS: A prospective cohort of 30 patients with esophageal squamous cell carcinoma who underwent minimally invasive esophagectomy with 2-field lymphadenectomy between January 2023 and December 2024 was evaluated. Preoperatively, indocyanine green dye (0.5 mL, 2.5 mg) was injected peritumoral in 4 quadrants. During lymphadenectomy, all indocyanine green-positive and -negative lymph nodes were retrieved and documented station-wise. On histopathology, the total number of lymph nodes retrieved was recorded, and indocyanine green positivity was correlated with histopathologic positivity as the primary endpoint.
RESULTS: The median age of the cohort was 51 years (interquartile range: 45-61 years). The commonest location of esophageal squamous cell carcinoma was lower thoracic (14 of 30, 47%), and all patients received neoadjuvant chemoradiotherapy, followed by minimally invasive esophagectomy. A total of 678 lymph nodes were retrieved, with a median of 23.5 lymph nodes per patient (interquartile range: 9-40). Overall, 56 of 678 lymph nodes (8.3%) were indocyanine green positive, of which 16 (28.6%) were positive for malignancy on histopathology. Among the 678 lymph nodes harvested, 20 (2.9%) were positive on histopathology, with 80% (16 of 20) being indocyanine green fluorescence positive. The indocyanine green positivity in lymph nodes had an 80% sensitivity, a 93% specificity, a 28.3% positive predictive value, and a 99.4% negative predictive value for accurately detecting histopathology-positive lymph nodes.
CONCLUSION: Esophagectomy with indocyanine green fluorescence-guided lymphadenectomy can serve as a complementary mapping tool to enhance the clearance of histopathology-positive lymph nodes. Indocyanine green-negative nodes showed a high negative predictive value but do not replace standard anatomic lymphadenectomy.