Fluorescent imaging with indocyanine green (ICG) can effectively guide lymphadenectomy in patients being operated on for gastric cancer, according to Korean researchers. Dr. Woo Jin Hyung of Yonsei University College of Medicine, Seoul, and colleagues enrolled 40 patients who underwent endoscopic peritumoral injection of ICG to the submucosal layer one day before robotic gastrectomy. 

Using near-infrared (NIR) imaging allowed them to perform complete lymphadenectomy for all patients and to assess the thoroughness of the lymphadenectomy intraoperatively.

The results were compared with those of 40 comparable historic controls who had previously undergone the same procedure without the use of ICG. Overall, there was a mean total of 48.9 lymph nodes retrieved per patient in the ICG group compared to 35.2 in the controls, a significant difference.

More lymph nodes were retrieved at nodal stations 2, 6, 7, 8 and 9. In addition, five NIR group patients exhibited lymph node metastases, and all were fluorescent. Thus, the researchers write in JAMA Surgery, online November 14, the findings "suggest that fluorescent lymphography may be useful intraoperatively for identifying and retrieving all necessary lymph nodes for a complete and thorough lymphadenectomy."

In an accompanying editorial, Dr. Marco G. Patti and colleagues at the University of North Carolina at Chapel Hill observe, "The use of ICG could increase the number of retrieved lymph nodes, allowing better staging and improving the cure rate."

Dr. Dan G. Blazer III of Duke University Medical Center, in Durham, North Carolina, said, "The extent of lymphadenectomy during gastrectomy for patients with resectable gastric cancer continues to be a lively debate in the surgical literature.

Lymph node dissection

Whether extended lymph node dissection offers a true therapeutic benefit versus just more accurate staging remains controversial. What is clear is that extended lymphadenectomy requires more technical skill and may be associated with increased morbidity."

Dr. Blazer, who specializes in the surgical management of patients with gastrointestinal malignancies, told Reuters Health by email that the study "is an intriguing effort by the investigators to use novel imaging techniques to achieve a lymphadenectomy comparable to traditionally extended lymph node dissection while minimizing surgical morbidity."