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Invited Commentary
November 14, 2018

Fluorescent-Guided Lymphography in Gastric Cancer Surgery: A Useful Adjunct for a Radical Lymph Node Dissection

Author Affiliations
  • 1Department of Medicine and Surgery and Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill
JAMA Surg. Published online November 14, 2018. doi:10.1001/jamasurg.2018.4303

In this issue of JAMA Surgery, Kwon and colleagues1 studied the use of fluorescent lymphography–guided lymphadenectomy during robotic gastrectomy for gastric cancer. They hypothesized that the peritumoral injection of indocyanine green (ICG) would allow for visualization of every draining lymph node from the primary lesion, therefore allowing a more complete and thorough lymphadenectomy. The day before the scheduled operation, they endoscopically injected 3 mg of ICG in the submucosa around the tumor in 40 patients who had a clinical stage I disease (T1N0M0, T1N1M0, or T2N0M0) according to the 7th staging system of the American Joint Commission on Cancer.2 The gastrectomy was performed using the da Vinci Si Surgical system (Intuitive) equipped with the Firefly mode to acquire near-infrared (NIR) fluorescent images. After propensity score matching, the results in these 40 patients were compared with those of 40 historical control patients who underwent robotic gastrectomy without injection of ICG. The primary outcome was the number of retrieved lymph nodes in total and in each nodal station. The results of their study clearly showed that the use of NIR imaging determined the retrieval of a higher number of harvested lymph nodes per patient, and for stations 2, 6, 7, 8, and 9.

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