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Hosogi H, Yoshida S, Sakaguchi M, Kanaya S. Neoadjuvant Chemoradiotherapy Followed by Minimally Invasive Esophagectomy for Borderline Resectable Esophageal Squamous Cell Carcinoma. J Gastrointest Surg 2023; 27:3040-3042. [PMID: 37919516 DOI: 10.1007/s11605-023-05876-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Hisahiro Hosogi
- Department of Surgery, Japanese Red Cross Osaka Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, 543-8555, Japan.
| | - Shinya Yoshida
- Department of Surgery, Japanese Red Cross Osaka Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, 543-8555, Japan
| | - Masazumi Sakaguchi
- Department of Surgery, Japanese Red Cross Osaka Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, 543-8555, Japan
- Department of Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Seiichiro Kanaya
- Department of Surgery, Japanese Red Cross Osaka Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, 543-8555, Japan
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Müller DT, Schiffmann LM, Reisewitz A, Chon SH, Eckhoff JA, Babic B, Schmidt T, Schröder W, Bruns CJ, Fuchs HF. Mapping the Lymphatic Drainage Pattern of Esophageal Cancer with Near-Infrared Fluorescent Imaging during Robotic Assisted Minimally Invasive Ivor Lewis Esophagectomy (RAMIE)-First Results of the Prospective ESOMAP Feasibility Trial. Cancers (Basel) 2023; 15:cancers15082247. [PMID: 37190175 DOI: 10.3390/cancers15082247] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 05/17/2023] Open
Abstract
While the sentinel lymph node concept is routinely applied in other surgical fields, no established and valid modality for lymph node mapping for esophageal cancer surgery currently exists. Near-infrared light fluorescence (NIR) using indocyanine green (ICG) has been recently proven to be a safe technology for peritumoral injection and consecutive lymph node mapping in small surgical cohorts, mostly without the usage of robotic technology. The aim of this study was to identify the lymphatic drainage pattern of esophageal cancer during highly standardized RAMIE and to correlate the intraoperative images with the histopathological dissemination of lymphatic metastases. Patients with clinically advanced stage squamous cell carcinoma or adenocarcinoma of the esophagus undergoing a RAMIE at our Center of Excellence for Surgery of the Upper Gastrointestinal Tract were prospectively included in this study. Patients were admitted on the day prior to surgery, and an additional EGD with endoscopic injection of the ICG solution around the tumor was performed. Intraoperative imaging procedures were performed using the Stryker 1688 or the FIREFLY fluorescence imaging system, and resected lymph nodes were sent to pathology. A total of 20 patients were included in the study, and feasibility and safety for the application of NIR using ICG during RAMIE were shown. NIR imaging to detect lymph node metastases can be safely performed during RAMIE. Further analyses in our center will focus on pathological analyses of ICG-positive tissue and quantification using artificial intelligence tools with a correlation of long-term follow-up data.
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Affiliation(s)
- Dolores T Müller
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Lars M Schiffmann
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Alissa Reisewitz
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Seung-Hun Chon
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Jennifer A Eckhoff
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Benjamin Babic
- Center for Esophagogastric Cancer Surgery Frankfurt, St. Elisabethen Hospital Frankfurt, D-60487 Frankfurt am Main, Germany
| | - Thomas Schmidt
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Wolfgang Schröder
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Christiane J Bruns
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Hans F Fuchs
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
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Hsu PK, Lee YY, Chuang LC, Wu YC. Lymph Node Dissection for Esophageal Squamous Cell Carcinoma. Thorac Surg Clin 2022; 32:497-510. [DOI: 10.1016/j.thorsurg.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Müller D, Stier R, Straatman J, Babic B, Schiffmann L, Eckhoff J, Schmidt T, Bruns C, Fuchs HF. [ICG lymph node mapping in cancer surgery of the upper gastrointestinal tract]. CHIRURGIE (HEIDELBERG, GERMANY) 2022; 93:925-933. [PMID: 35925142 DOI: 10.1007/s00104-022-01659-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
The importance of the assessment of the N‑status in gastric carcinoma, tumors of the gastroesophageal junction and esophageal cancer is undisputed; however, there is currently no internationally validated method for lymph node mapping in esophageal and gastric cancer. Near-infrared fluorescence imaging (NIR) is an innovative technique from the field of vibrational spectroscopy, which in combination with the fluorescent dye indocyanine green (ICG) enables intraoperative real-time visualization of anatomical structures. The ICG currently has four fields of application in oncological surgery: intraoperative real-time angiography for visualization of perfusion, lymphography for visualization of lymphatic vessels, visualization of solid tumors, and (sentinel) lymph node mapping. For imaging of the lymph drainage area and therefore the consecutive lymph nodes, peritumoral injection of ICG must be performed. Several studies have demonstrated the feasibility of peritumoral injection of ICG administered 15 min to 3 days preoperatively with subsequent intraoperative visualization of the lymph nodes. So far prospective randomized studies on the validation of the method are still lacking. In contrast, the use of ICG for lymph node mapping and visualization of sentinel lymph nodes in gastric cancer has been performed in large cohorts as well as in prospective randomized settings. Up to now, multicenter studies for ICG-guided lymph node mapping during oncological surgery of the upper gastrointestinal tract are lacking. Artificial intelligence methods can help to evaluate these techniques in an automated manner in the future as well as to support intraoperative decision making and therefore to improve the quality of oncological surgery.
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Affiliation(s)
- Dolores Müller
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Raphael Stier
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Jennifer Straatman
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Benjamin Babic
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Lars Schiffmann
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Jennifer Eckhoff
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Thomas Schmidt
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Christiane Bruns
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Hans F Fuchs
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland.
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Wong IYH, Zhang RQ, Tsang RKY, Kwok JYY, Wong CLY, Chan DKK, Chan FSY, Law SYK. Improving Outcome of Superior Mediastinal Lymph Node Dissection During Esophagectomy: A Novel Approach Combining Continuous and Intermittent Recurrent Laryngeal Nerve Monitoring. Ann Surg 2021; 274:736-742. [PMID: 34310354 DOI: 10.1097/sla.0000000000005096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed at demonstrating the effects and learning curve of utilizing combined intermittent and continuous recurrent laryngeal nerve (RLN) monitoring for lymphadenectomy during esophagectomy. BACKGROUND RLN lymphadenectomy is oncologically important but is technically demanding. Vocal cord (VC) palsy as a result from RLN injury, carries significant morbidities. METHODS This is a retrospective study of consecutive esophageal squamous cell carcinoma (ESCC) patients who underwent transthoracic esophagectomy from 2010 to 2020. Combined nerve monitoring (CNM) included: CNM which involved a periodic stimulating left vagal electrode and intermittent nerve monitoring which utilized a stimulating probe to identify the RLNs. The integrity of the RLNs was assessed both intermittently and continuously. This technique was introduced in 2014. Patients were divided into "before CNM" and "CNM" groups. The primary outcome was the difference in number of RLN lymph nodes harvested and VC palsy rate. Learning curves were demonstrated by cumulative sum (CUSUM) analysis. RESULTS Two hundred and fifty-five patients were included with 157 patients in "CNM" group. The mean number of RLN lymph nodes harvested was significantly higher (4.31 vs 0.45, P < 0.0001) for the "CNM" group. VC palsy rates were significantly lower (17.8% vs 32.7%, P = 0.007). There was an initial increase in VC palsy rate, peaked at around 46 cases. The increase in lymph nodes harvested above the mean plateaued at around 96 cases. CONCLUSIONS CNM helped improve bilateral RLN lymphadenectomy. Lymph node harvesting was increased with reduction of VC palsy after a learning curve.
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Affiliation(s)
- Ian Y H Wong
- Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
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