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Assessment of indocyanine green fluorescence lymphography on lymphadenectomy during minimally invasive gastric cancer surgery: a systematic review and meta-analysis

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Abstract

Background

In recent years, indocyanine green fluorescence lymphography has been introduced for lymphatic mapping in gastric cancer surgery. The aim of this study was to investigate the efficacy of ICGFL in lymph node dissection during minimally invasive surgery for gastric cancer.

Methods

A systematic review of electronic databases including PubMed, Embase, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure was performed from the inception to January 2021 for all studies comparing ICGFL with non-ICGFL in GC patients undergoing minimal access gastrectomy. The primary outcome was the total number of harvested lymph nodes. The secondary endpoints were the number of metastatic LNs, operative time, estimated blood loss, and postoperative complications. The registration number of this protocol is PROSPERO CRD42020203443.

Results

A total of 13 studies including 1882 participants were included. In this meta-analysis, the use of ICGFL was associated with a higher number of harvested LNs (40.33 vs. 33.40; MD = 6.93; 95%CI: 4.28 to 9.58; P < 0.0001; I2 = 86%). No significant difference was found between the ICGFL and control groups in terms of metastatic LNs (2.63 vs. 2.42; MD = 0.21; 95%CI: −0.46 to 0.87; P = 0.54; I2 = 0%). In addition, the use of ICGFL could be safely performed without increasing the operative time (P = 0.49), estimated blood loss (P = 0.26) and postoperative complications (P = 0.54).

Conclusion

The use of ICGFL may be a useful tool facilitating complete lymph node dissection during minimally invasive GC resection. However, more high-quality RCTs with large sample size are needed to validate this issue.

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Acknowledgements

This paper was supported by the Fund of Ten Thousand Talents Program of Sichuan Province and Science and Technology Department of Sichuan Province.

Funding

This study was funded by (1) Ten Thousand Talents Program of Sichuan Province (No.101) and (2) Science and Technology Department of Sichuan Province (Nos. 2020SZ0147, 2019YFS0255).

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Author notes

  1. Hua-Yang Pang and Xian-Wen Liang are Co-first authorships.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China

    Hua-Yang Pang, Xian-Wen Liang, Xiao-Long Chen, Lin-Yong Zhao, Kai Liu, Wei-Han Zhang, Kun Yang, Xin-Zu Chen & Jian-Kun Hu

  2. West China School of Medicine, Sichuan University, Chengdu, China

    Quan Zhou

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Correspondence to Jian-Kun Hu.

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Hua-Yang Pang, Xian-Wen Liang, Xiao-Long Chen, Quan Zhou, Lin-Yong Zhao, Kai Liu, Wei-Han Zhang, Kun Yang, Xin-Zu Chen, and Jian-Kun Hu have no conflict of interest or financial ties to disclose.

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Pang, HY., Liang, XW., Chen, XL. et al. Assessment of indocyanine green fluorescence lymphography on lymphadenectomy during minimally invasive gastric cancer surgery: a systematic review and meta-analysis. Surg Endosc 36, 1726–1738 (2022). https://doi.org/10.1007/s00464-021-08830-2

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