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The histopathological evaluation based on the indocyanine green fluorescence imaging of regional lymph node metastasis of splenic flexural colon cancer by near-infrared observation

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to investigate the relationship between the fluorescence on indocyanine green fluorescent imaging (ICG-FI) and the histopathological findings of regional lymph node (LN) metastasis of splenic flexural colon cancer.

Methods

From July 2013 to December 2018, consecutive patients with splenic flexural colon cancer with a preoperative diagnosis of N0 who underwent laparoscopic surgery were enrolled. The distribution of cancer sites in metastatic LNs (completely/not completely occupied by metastatic foci) was evaluated with hematoxylin and eosin–stained preparations. We compared the relationship between the distribution of cancer site and fluorescence of paraffin block in metastatic LNs.

Results

Seventy-two patients were enrolled, of whom 13 (18.1%) had metastatic LNs. A total of 25 metastatic LNs were evaluated. The median short axis of the occupied LNs was 4.5 mm, which was significantly larger than that of the non-occupied LNs (3.0 mm; p = 0.036). In the near-infrared observation of the paraffin block, the completely occupied LNs showed no fluorescence, regardless of the LN size, but 8 of 10 non-occupied LNs showed fluorescence (p < 0.001). Even the non-occupied LNs that showed fluorescence, the cancer site did not show fluorescence.

Conclusions

The occupied LNs showed no fluorescence, but 80% of the non-occupied LNs showed fluorescence. Even in non-occupied LNs that showed fluorescence, the cancer site did not show fluorescence. This demonstrated LN dissection should not be omitted, even if no fluorescence is noted on intraoperative ICG-FI.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgments

The authors thank Yukio Tsuura at the Department of Pathology, Yokosuka Kyosai Hospital, for his pathological contribution to this study.

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Authors and Affiliations

  1. Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan

    Manabu Kakizoe, Hirokazu Suwa, Hidenobu Masui & Kaoru Nagahori

  2. Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan

    Jun Watanabe & Yusuke Suwa

  3. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Kazuya Nakagawa, Mayumi Ozawa & Atsushi Ishibe

Authors
  1. Manabu Kakizoe
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  2. Jun Watanabe
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  3. Yusuke Suwa
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  4. Kazuya Nakagawa
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  5. Hirokazu Suwa
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  6. Mayumi Ozawa
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  7. Atsushi Ishibe
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  8. Hidenobu Masui
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  9. Kaoru Nagahori
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Contributions

Jun Watanabe contributed to the study design. All of the authors contributed to the data collection, data analysis, and interpretation. Jun Watanabe and Manabu Kakizoe contributed to the statistical analyses. All of the authors contributed to the writing or review of the report and approved the final version.

Corresponding author

Correspondence to Jun Watanabe.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval

The study protocol was approved by the Ethical Advisory Committee of Yokosuka Kyosai Hospital.

Consent to participate

All patients provided their written informed consent before enrolling in the study.

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Not applicable.

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Kakizoe, M., Watanabe, J., Suwa, Y. et al. The histopathological evaluation based on the indocyanine green fluorescence imaging of regional lymph node metastasis of splenic flexural colon cancer by near-infrared observation. Int J Colorectal Dis 36, 717–723 (2021). https://doi.org/10.1007/s00384-020-03798-2

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  • DOI: https://doi.org/10.1007/s00384-020-03798-2

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