Objective:
This study evaluates the effectiveness of indocyanine green (ICG)-guided lymph node (LN) dissection during laparoscopic radical gastrectomy post-neoadjuvant chemotherapy (NAC) in locally advanced gastric cancer (LAGC) patients.
Background:
ICG fluorescence has been shown to improve LN mapping in various cancers. However, its application in LAGC post-NAC remains underexplored.
Methods:
Patients with clinical T2-4NanyM0 gastric adenocarcinoma were randomized into ICG-guided and non-ICG groups. Key secondary endpoints included the quality of lymphadenectomy and surgical outcomes.
Results:
Out of 240 patients randomized, 236 were analyzed. The ICG group had a significantly higher mean number of retrieved LNs within D2 dissection compared to the non-ICG group (48.2 vs. 38.3, P < 0.001). The ICG group also showed a significantly reduced LN noncompliance rate (33.9% vs. 55.1%, P = 0.001). Additionally, in patients without baseline measurable LNs, ICG significantly increased the number of retrieved LNs and decreased the LN noncompliance rate. Surgical outcomes were comparable between the groups.
Conclusion:
ICG-guided lymphadenectomy improves LN dissection quality in LAGC patients undergoing laparoscopic radical gastrectomy post-NAC, without compromising surgical outcomes. This technique is particularly beneficial in patients without baseline measurable LNs and those achieving complete response post-NAC.
DOI: Read here
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