吲哚菁绿荧光导航的侧方前哨淋巴结活检在腹腔镜直肠癌侧方淋巴结清扫中的临床意义

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中文摘要：目的探讨应用吲哚菁绿（ICG）荧光导航技术的直肠癌侧方前哨淋巴结活检（SLNB）在腹腔镜直肠癌侧方淋巴结清扫（LLND）中的临床意义，评估该技术预测侧方淋巴结（LPLN）状态的准确性和可行性。方法回顾性分析2017年4月至2022年10月中国医学科学院肿瘤医院结直肠外科在腹腔镜直肠癌LLND术中行ICG荧光导航的侧方SLNB的16例直肠癌患者的临床病理资料。入组患者未行术前新辅助放疗且LPLN可见但未明确转移（在高分辨率MRI图像中，LPLN最大短径为5.0～9.9 mm）。随访观察患者的术后并发症。结果 16例患者均在腹腔镜直肠癌LLND术中成功完成ICG荧光导航的侧方SLNB。3例患者行双侧LLND，13例患者行单侧LLND。14例患者侧方前哨淋巴结（SLN）可见明显荧光显像，SLN检出率为87.5%。其中2例患者侧方SLN术中冰冻病理发现肿瘤转移，12例患者侧方SLN术中冰冻病理阴性。在14例侧方SLN荧光显像的患者中，侧方清扫的非前哨淋巴结（NSLB）均为阴性。2例无侧方SLN荧光显像的患者，所有切除的LPLN均为阴性。SLNB的特异度为85.7%，灵敏度、阴性预测值和准确性均为100%。术后1例患者出现切口感染，1例患者出现造口周围皮炎。结论 ICG荧光导航的侧方SLNB在预测LPLN状态方面安全可行，并具有良好的准确性，该技术有望替代局部晚期直肠癌的预防性LLND。 Objectives This study aims to explore the clinical significance of lateral pelvic sentinel lymph node biopsy (SLNB) using indocyanine green (ICG) fluorescence navigation in laparoscopic lateral pelvic lymph node dissection (LLND) and evaluate the accuracy and feasibility of this technique to predict the status of lateral pelvic lymph nodes (LPLNs). Methods The clinical and pathological characteristics, surgical outcomes, lymph node findings and perioperative complications of 16 rectal cancer patients who underwent SLNB using ICG fluorescence navigation in laparoscopic LLND in the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College during April 2017 and October 2022 were retrospectively collected and analyzed. The patients did not receive preoperative neoadjuvant radiotherapy and presented with LPLNs but without LPLN enlargement (MRI showed the maximum short axes of the LPLNs were ≥5 mm and <10 mm at first visit). Results All 16 patients were successfully performed SLNB using ICG fluorescence navigation in laparoscopic LLND. Three patients underwent bilateral LLND and 13 patients underwent unilateral LLND. The lateral pelvic sentinel lymph nodes (SLNs) were clearly fluorescent before dissection in 14 patients and the detection rate of SLNs for these patients was 87.5%. Lateral pelvic SLN metastasis was diagnosed in 2 patients and negative results were found in 12 patients by frozen pathological examinations. Among the 14 patients in whom lateral pelvic SLNs were detected, the dissected lateral pelvic non-SLNs were all negative. All dissected LPLNs were negative in two patients without fluorescent lateral pelvic SLNs. The specificity, sensitivity, negative predictive value, and accuracy was 85.7%, 100%, 100%, and 100%, respectively. Conclusions This study indicates that lateral pelvic SLNB using ICG fluorescence navigation shows promise as a safe and feasible procedure with good accuracy. This technique may replace preventive LLND for locally advanced lower rectal cancer.

外文标题：The clinical significance of lateral pelvic sentinel lymph node biopsy using indocyanine green fluorescence navigation in laparoscopic lateral pelvic lymph node dissection

外文摘要：Objectives This study aims to explore the clinical significance of lateral pelvic sentinel lymph node biopsy (SLNB) using indocyanine green (ICG) fluorescence navigation in laparoscopic lateral pelvic lymph node dissection (LLND) and evaluate the accuracy and feasibility of this technique to predict the status of lateral pelvic lymph nodes (LPLNs). Methods The clinical and pathological characteristics, surgical outcomes, lymph node findings and perioperative complications of 16 rectal cancer patients who underwent SLNB using ICG fluorescence navigation in laparoscopic LLND in the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College during April 2017 and October 2022 were retrospectively collected and analyzed. The patients did not receive preoperative neoadjuvant radiotherapy and presented with LPLNs but without LPLN enlargement (MRI showed the maximum short axes of the LPLNs were ≥5 mm and <10 mm at first visit). Results All 16 patients were successfully performed SLNB using ICG fluorescence navigation in laparoscopic LLND. Three patients underwent bilateral LLND and 13 patients underwent unilateral LLND. The lateral pelvic sentinel lymph nodes (SLNs) were clearly fluorescent before dissection in 14 patients and the detection rate of SLNs for these patients was 87.5%. Lateral pelvic SLN metastasis was diagnosed in 2 patients and negative results were found in 12 patients by frozen pathological examinations. Among the 14 patients in whom lateral pelvic SLNs were detected, the dissected lateral pelvic non-SLNs were all negative. All dissected LPLNs were negative in two patients without fluorescent lateral pelvic SLNs. The specificity, sensitivity, negative predictive value, and accuracy was 85.7%, 100%, 100%, and 100%, respectively. Conclusions This study indicates that lateral pelvic SLNB using ICG fluorescence navigation shows promise as a safe and feasible procedure with good accuracy. This technique may replace preventive LLND for locally advanced lower rectal cancer.

外文关键词：

Rectal neoplasmsLateral pelvic lymph node dissectionSentinel lymph nodeIndocyanine green fluorescence navigation

作者：

苏昊、徐正、包满都拉、罗寿、梁建伟、裴炜、关旭、刘正、姜争、张明光、赵志勋、金伟森、周海涛、王书亚

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作者单位：

北京大学肿瘤医院暨北京市肿瘤防治研究所，恶性肿瘤发病机制及转化研究教育部重点实验室胃肠肿瘤中心，北京100142

国家癌症中心　国家肿瘤临床医学研究中心　中国医学科学院北京协和医学院肿瘤医院结直肠外科，北京100021

国家癌症中心　国家肿瘤临床医学研究中心　中国医学科学院北京协和医学院肿瘤医院胰胃外科，北京100021

国家癌症中心　国家肿瘤临床医学研究中心　中国医学科学院北京协和医学院肿瘤医院深圳医院胃肠外科，深圳518116

解放军总医院第三医学中心肛肠外科，北京100039

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关键词：

直肠肿瘤侧方淋巴结清扫前哨淋巴结吲哚菁绿荧光导航

基金：

北京大学肿瘤医院科学研究基金中国医学科学院医学与健康科技创新工程协同创新团队项目中国医学科学院医学与健康科技创新工程重大协同创新项目国家卫生健康委医药卫生科技发展研究中心2021年微创手术临床应用规范研究课题中国医学科学院肿瘤医院抗癌“希望之星”课题国家重点研发计划国家重点研发计划中国癌症基金会北京希望马拉松专项基金

项目编号：

2022-92017-I2M-4-0022021-I2M-1-010WA2021RW132023YFC34038002023YFC3403804LC2022A01

出版年：

2024

DOI：

10.3760/cma.j.cn112152-20231026-00265

中华肿瘤杂志

中华医学会

中华肿瘤杂志

CSTPCD北大核心

影响因子：1.908

ISSN：0253-3766

年,卷(期)：2024.46(2)

参考文献量21