S122: Impact of Fluorescence and 3D Images to Completeness of Lateral Pelvic Node Dissection

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2019 May 30

PMID 31139999

Citations 13

Authors

Hye Jin Kim

Gyu-Seog Choi

Jun Seok Park

Soo Yeun Park

Seung Hyun Cho

An Na Seo

Ghuil Suk Yoon

Affiliations

Soon will be listed here.

Abstract

Background: Lateral pelvic lymph node dissection (LPND) is a technically demanding procedure. Consequently, there is a possibility of incomplete dissection of lateral pelvic lymph nodes (LPNs). We aimed to identify metastatic LPNs intraoperatively in real-time under dual guidance of fluorescence imaging and 3D lymphovascular reconstruction, and then to remove them completely.

Methods: Rectal cancer patients who were scheduled to undergo LPND after preoperative chemoradiotherapy (CRT) were prospectively enrolled. We traced changes in suspected metastatic LPNs during preoperative CRT and defined them as index LPNs on post-CRT imaging studies. For fluorescence imaging, indocyanine green (ICG) at a dose of 2.5 mg was injected transanally around the tumor before the operation. For 3D reconstruction images, each patient underwent preoperative axial CT scan with contrast (0.6 mm slice thickness). These images were then manipulated with OsiriX. Index LPNs and essential structures in the pelvic sidewall, such as the obturator nerve, were reconstructed with abdominal arteries from 3D volume rendering. All surgical procedures were performed via laparoscopic or robotic approach.

Results: From March to July 2017, ten rectal cancer patients underwent total mesorectal excision with LPND after preoperative CRT under dual image guidance. Bilateral LPND was performed in five patients. All index LPNs among ICG-bearing lymph nodes were clearly identified intraoperatively by matching with their corresponding 3D images. Pathologic LPN metastasis was confirmed in four patients (40.0%) and in five of the 15 dissected pelvic sidewalls (33.0%). All metastatic LPNs were identified among index LPNs. Four (80.0%) of the five metastatic LPNs were located in the internal iliac area.

Conclusion: Index LPNs among ICG-bearing lymph nodes in pelvic sidewall were clearly identified and completely removed by matching with their corresponding 3D reconstruction images. Further studies and long-term oncologic outcomes are required to determine the real impact of dual image guidance in LPND.

Citing Articles

Surgical navigation for lateral pelvic lymph node dissection in rectal cancer.

Ochiai K, Ishihara S Tech Coloproctol. 2025; 29(1):63.

PMID: 39937208 DOI: 10.1007/s10151-024-03084-1.

Efficacy and Safety of Fluorescence-Guided Surgery Compared to Conventional Surgery in the Management of Colorectal Cancer: A Systematic Review and Meta-Analysis.

Fadel M, Zonoobi E, Rodriguez-Luna M, Mishima K, Ris F, Diana M Cancers (Basel). 2024; 16(19).

PMID: 39409997 PMC: 11476237. DOI: 10.3390/cancers16193377.

The role of lateral pelvic lymph node dissection in advanced rectal cancer: a review of current evidence and outcomes.

Choi G, Kim H Ann Coloproctol. 2024; 40(4):363-374.

PMID: 39228199 PMC: 11375230. DOI: 10.3393/ac.2024.00521.0074.

Role of Lateral Pelvic Node Dissection in Rectal Cancer Surgery.

Ozgur I, Gorgun E Clin Colon Rectal Surg. 2024; 37(4):222-228.

PMID: 38882936 PMC: 11178386. DOI: 10.1055/s-0043-1770711.

The use of indocyanine green for lateral lymph node dissection in rectal cancer-preliminary data from an emerging procedure: a systematic review of the literature.

Kehagias D, Lampropoulos C, Bellou A, Kehagias I Tech Coloproctol. 2024; 28(1):53.

PMID: 38761271 PMC: 11102372. DOI: 10.1007/s10151-024-02930-6.

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