Abstract
OBJECTIVES: To investigate the effectiveness of indocyanine green (ICG) lymphography in improving lymph nodes (LNs) harvesting during laparoscopic radical distal gastrectomy for gastric cancer. DESIGN: Non-randomized trial, prospective study compared ICG and non-ICG group using 1:1 propensity score matching (PSM) method. SETTING: Preoperative clinical characteristics, operative outcomes, and follow-up results. PARTICIPANTS: 242 patients who underwent laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer between 2019 and 2023. After exclusion and PSM, 160 patients (Pts) were included, paired in two groups: ICG (80 Pts) and non-ICG (80 Pts). INTERVENTIONS: Patients in the ICG group underwent ICG injection submucosal via endoscopy 1 day before surgery. MAIN OUTCOME MEASURES: Comparison of the number of retrieved LNs and complications between the ICG and non-ICG group. RESULTS: There were no significant differences in age, sex, height, tumor size, pathological Tumor-stage, histological differentiation, and complications between the two groups. There was a shorter operative time in the ICG group compared with the non-ICG group (median: 118 mins (IQR, 105-135) vs 146 mins (IQR, 120-180), respectively). Regarding the effectiveness of LN dissection: the ICG group had a higher median of retrieved LNs than the non-ICG group (36 LNs (IQR, 29-46) vs 27 LNs (IQR, 21-31); p<0.001). The mean number of metastatic LNs in the ICG group was significantly higher than in the non-ICG group, with 2.6±5.4 LNs compared with 0.9±3.1 LNs, respectively (p=0.018). The proportion of patients with more than 25 and 30 retrieved LNs was higher in the ICG group compared with the non-ICG group, with rates of 86% and 71% versus 64% and 31%, respectively (p<0.001). CONCLUSIONS: Using ICG fluorescence-guided LNs dissection has increased both the number of total LNs and metastatic LNs dissection without increasing complications in laparoscopic distal gastrectomy for gastric cancer.