European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2025
Indocyanine green-guided lymphadenectomy in gastric cancer after neoadjuvant chemotherapy: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Fernandes Marcelo Henrique Ferreira, Valério-Alves Ana Paula, Colares Raphaela Anderson, de França Xavier José Vitor, Batista Thales Paulo, Martins Filho Euclides Dias, Morriello Rafael, Kassab Paulo
Аннотация
INTRODUCTION: Indocyanine green (ICG) fluorescence imaging is emerging as a valuable tool in gastric cancer (GC) surgery. However, concerns remain about whether its efficacy is diminished following neoadjuvant chemotherapy (NAC), and its use remains controversial.
MATERIAL AND METHODS: We searched PubMed, Embase and Cochrane Library for studies comparing ICG-guided with conventional lymphadenectomy in GC patients following NAC. The main outcomes were the total number of retrieved lymph nodes (LNR), proportion of patients with ≥30 LNs retrieved (PLN), non-compliance rate (NCR), estimated blood loss (EBL), length of hospital stay (LOS), operative time (OT) and overall complications (OC). Statistical analyses were performed using Review Manager 5.4.1.
RESULTS: Five studies involving 694 patients treated with NAT were included, of which 344 used ICG and 350 conventional surgeries. ICG significantly increased LNR (MD = 8.98; 95 % CI: 6.76-11.20; p < 0.00001; I2 = 0 %), raised the chance of ≥30 LNs (RR = 1.31; 95 % CI: 1.19-1.44; p < 0.00001; I2 = 0 %), and reduced LN non-compliance (RR = 0.65; 95 % CI: 0.52-0.81; p < 0.0001; I2 = 0 %). Operative time was a little longer (MD = 7.73 min; 95 % CI: 4.72-10.73; p = 0.004; I2 = 0 %). ICG slightly reduced blood loss (MD = -26.22 mL; 95 % CI: -49.76 to -2.69; p = 0.04; I2 = 56 %) and length of stay (MD = -0.36 days; 95 % CI: -0.64 to -0.07; p = 0.03; I2 = 0 %), with similar overall complications (RR = 0.92; 95 % CI: 0.79-1.08; p = 0.20; I2 = 0 %).
CONCLUSIONS: ICG guidance improves the quality of D2 lymphadenectomy after NAC by higher nodal yield, greater likelihood of obtaining ≥30 LNs, and lower non-compliance rate, without increased morbidity. These findings highlight the potential of ICG to enhance surgical outcomes in this population.
MATERIAL AND METHODS: We searched PubMed, Embase and Cochrane Library for studies comparing ICG-guided with conventional lymphadenectomy in GC patients following NAC. The main outcomes were the total number of retrieved lymph nodes (LNR), proportion of patients with ≥30 LNs retrieved (PLN), non-compliance rate (NCR), estimated blood loss (EBL), length of hospital stay (LOS), operative time (OT) and overall complications (OC). Statistical analyses were performed using Review Manager 5.4.1.
RESULTS: Five studies involving 694 patients treated with NAT were included, of which 344 used ICG and 350 conventional surgeries. ICG significantly increased LNR (MD = 8.98; 95 % CI: 6.76-11.20; p < 0.00001; I2 = 0 %), raised the chance of ≥30 LNs (RR = 1.31; 95 % CI: 1.19-1.44; p < 0.00001; I2 = 0 %), and reduced LN non-compliance (RR = 0.65; 95 % CI: 0.52-0.81; p < 0.0001; I2 = 0 %). Operative time was a little longer (MD = 7.73 min; 95 % CI: 4.72-10.73; p = 0.004; I2 = 0 %). ICG slightly reduced blood loss (MD = -26.22 mL; 95 % CI: -49.76 to -2.69; p = 0.04; I2 = 56 %) and length of stay (MD = -0.36 days; 95 % CI: -0.64 to -0.07; p = 0.03; I2 = 0 %), with similar overall complications (RR = 0.92; 95 % CI: 0.79-1.08; p = 0.20; I2 = 0 %).
CONCLUSIONS: ICG guidance improves the quality of D2 lymphadenectomy after NAC by higher nodal yield, greater likelihood of obtaining ≥30 LNs, and lower non-compliance rate, without increased morbidity. These findings highlight the potential of ICG to enhance surgical outcomes in this population.