Calcara C, Cocciolillo S, Marten Canavesio Y, Adamo V, Carenzi S, Lucci DI, Premoli A. Endoscopic fluorescent lymphography for gastric cancer. World J Gastrointest Endosc 2023; 15(2): 32-43 [PMID: 36925646 DOI: 10.4253/wjge.v15.i2.32]
Corresponding Author of This Article
Calcedonio Calcara, MD, Director, Digestive Endoscopy Unit, S. Andrea Hospital, Corso Mario Abbiate No. 21, Vercelli 13100, Italy. calcedonio.calcara@aslvc.piemonte.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Feb 16, 2023; 15(2): 32-43 Published online Feb 16, 2023. doi: 10.4253/wjge.v15.i2.32
Endoscopic fluorescent lymphography for gastric cancer
Calcedonio Calcara, Sila Cocciolillo, Ylenia Marten Canavesio, Vincenzo Adamo, Silvia Carenzi, Daria Ilenia Lucci, Alberto Premoli
Calcedonio Calcara, Silvia Carenzi, Daria Ilenia Lucci, Alberto Premoli, Digestive Endoscopy Unit, S. Andrea Hospital, Vercelli 13100, Italy
Sila Cocciolillo, Digestive Endoscopy Unit, Padre Pio Hospital, Vasto 66054, Italy
Ylenia Marten Canavesio, Postgraduate School of Gastroenterology, Genova University, Genova 16132, Italy
Vincenzo Adamo, General Surgery Unit, S. Andrea Hospital, Vercelli 13100, Italy
Author contributions: Calcara C and Cocciolillo S wrote the manuscript; Canavesio YM, Adamo V, Carenzi S, Lucci DI and Premoli A reviewed the literature; All authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Calcedonio Calcara, MD, Director, Digestive Endoscopy Unit, S. Andrea Hospital, Corso Mario Abbiate No. 21, Vercelli 13100, Italy. calcedonio.calcara@aslvc.piemonte.it
Received: September 20, 2022 Peer-review started: September 20, 2022 First decision: November 25, 2022 Revised: December 18, 2022 Accepted: February 7, 2023 Article in press: February 7, 2023 Published online: February 16, 2023
Abstract
Lymphography by radioisotope or dye is a well-known technique for visualizing the lymphatic drainage pattern in a neoplastic lesion and it is in use in gastric cancer. Indocyanine green (ICG) more recently has been validated in fluorescent lymphography studies and is under evaluation as a novel tracer agent in gastric cancer. The amount and dilution of ICG injected as well as the site and the time of the injection are not standardized. In our unit, endoscopic submucosal injections of ICG are made as 0.5 mg in 0.5 mL at four peritumoral sites the day before surgery (for a total of 2.0 mg in 2.0 mL). Detection instruments for ICG fluorescence are evolving. Near-infrared systems integrated into laparoscopic or robotic instruments (near-infrared fluorescence imaging) have shown the most promising results. ICG fluorescence recognizes the node that receives lymphatic flow directly from a primary tumor. This is defined as the sentinel lymph node, and it has a high predictive negative value at the cT1 stage, able to reduce the extent of gastrectomy and lymph node dissection. ICG also enhances the number of lymph nodes detected during extended lymphadenectomy for advanced gastric cancer. Nevertheless, the practical effects of ICG use in a single patient are not yet clear. Standardization of the technique and further studies are needed before fluorescent lymphography can be used extensively worldwide. Until then, current guidelines recommend an extensive lymphadenectomy as the standard approach for gastric cancer with suspected metastasis.
Core Tip: Endoscopic injection of indocyanine green (ICG) the day before surgery is a simple technique that could increase the number of lymph nodes recovered during lymphadenectomy for advanced gastric cancer. In addition, ICG-guided sentinel lymph node detection could reduce unnecessary extensive lymphadenectomy and the amount of gastric resection in early gastric cancer. However, further research is needed to confirm its usefulness in both scenarios. Currently, D1/D2 Lymphadenectomy remains the standard of care for gastric cancer with suspected metastasis. Our review explores this topic in depth and provides practical information for the endoscopic use of ICG.
