Indocyanine green-guided lymphadenectomy in gastric cancer after neoadjuvant chemotherapy: A systematic review and meta-analysis.

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.