Titolo della tesi: Linfoadenectomia guidata dall’imaging a fluorescenza mediante verde di indocianina e tecnologia near infrared nella gastrectomia robotica
Objectives: The objective of this study was verifying the feasibility and the role of a lymphadenectomy assisted by fluorescence imaging during robotic gastrectomy.
Methods: This is an interventional prospective study. Inclusion criteria: cT1-cT3 and cN0-N+. Description: the day before surgery, the ICG was injected endoscopically into the submucosa around the tumor (0.83mg / mL, 0.3mL x 4-6). Each
patient underwent a robotic total D2 gastrectomy. The lymph node stations were sent to the pathologist in different containers and further subdivided according to fluorescence.
Results: Twenty patients were included in this study (Female=65%; mean age=73±9.56y). Among the pathological findings: mean tumor size=41.4mm±28.03; EGC was found in 45% of cases; 45% of patients had no Lns metastases
(N0, no.=9), 20% had up to 2 metastic Lns (N1, no.=4), 5% 3 to 6 metastic Lns (N2, no.=1) and 30% a significant lymphnode spread with more than 7 metastatic Lns (N3a, no.=3; N3b no.=3). The 60% of patients showed an advanced
stage of disease (II-III). No intraoperative major complications occurred. The total operative time was 324.61min±80.85, the EBL=103ml±102.83. The fluorescence detection rate was 100%. The total number of Lns analyzed was 1522Lns with
a mean per patient=76.1Lns±25.41. The number of positive Lns for metastasis was 115Lns (mean=5.75Lns±9.11), consequently 1407Lns were free from disease. Total perigastric Lns=1155 (75.88%), while total extra-perigastric
Lns=355 (24.12%). In the fluorescent tissue, 1349Lns were identified (88.63%). All the 115 metastatic Lns were fluorescent, while all Lns found in the non-fluorescent tissue areas were free from disease.
Conclusions: Some advantages were found: easier detection of nodes in the adipose tissue and dissection in challenging anatomical sites, detection of small Lns that may escape at the normal view, checking the completeness of the
lymphadenectomy at the end of the procedure.