Esophagectomy with lymphadenectomy guided by fluorescence imaging with indocyanine green in esophageal cancer. Initial experience in Argentina

Abstract

Background: Over the past decade, fluorescence imaging with infrared light has been used to visualize lymph nodes in tumors of the stomach and esophagus.
Objective: The aim of our study was to evaluate the feasibility of evaluating lymphatic drainage in esophageal cancer using fluorescence and indocyanine green (ICG).
Material and methods: We conducted a prospective study of patients with resectable tumors of the gastroesophageal junction (stage I, II and III). Before surgery, 4 mL of ICG double diluted in sterile water (1.25 mg/mL = 5 mg) were injected via endoscopy into the esophageal submucosa in the four quadrants (1 mL per quadrant) around the tumor.
Results: A total of 6 patients were included. Lymphatic drainage from the tumor to the first lymph node station was identified in all patients: in 6/6 (100%), fluorescent lymphatic drainage was detected in nodal stations number 3 and 7 (lesser curvature and left gastric artery) Fluorescence was not identified in the mediastinal lymph nodes in any patient.
Conclusion: Visualization of lymphatic drainage of gastroesophageal junction tumors to the lesser curvature nodes using fluorescence imaging is feasible.