TY - JOUR
T1 - Use of fluorescence imaging and indocyanine green for sentinel node mapping during gastric cancer surgery
T2 - Results of an intercontinental Delphi survey
AU - Sherwinter, Danny A.
AU - Boni, Luigi
AU - Bouvet, Michael
AU - Ferri, Lorenzo
AU - Hyung, Woo Jin
AU - Ishizawa, Takeaki
AU - Kaleya, Ronald N.
AU - Kelly, Kaitlyn
AU - Kokudo, Norihiro
AU - Lanzarini, Enrique
AU - Luyer, Misha D.P.
AU - Mitsumori, Norio
AU - Mueller, Carmen
AU - Park, Doo Joong
AU - Ribero, Dario
AU - Rosati, Riccardo
AU - Ruurda, Jelle P.
AU - Sosef, Meindert
AU - Schneider-Koraith, Sylke
AU - Spinoglio, Giuseppe
AU - Strong, Vivian
AU - Takahashi, Naoto
AU - Takeuchi, Hiroya
AU - Wijnhoven, Bas P.L.
AU - Yang, Han Kwang
AU - Dip, Fernando
AU - Lo Menzo, Emanuele
AU - White, Kevin P.
AU - Rosenthal, Raul J.
N1 - Funding/Support:
Diagnostic Green; Intuitive; Medtronic; Olympus; Karl Storz;
Stryker: Each provided unrestricted grants for the International
Society for Fluorescence Guided Surgery (ISFGS) Advisory Board
meeting, Frankfurt, Germany, September 8, 2019, during which the
Delphi consensus was discussed. Diagnostic Green also funded
accommodations and meals. Diagnostic Green, Medtronic, Karl
Storz, Stryker, Arthrex, and Richard Wolf provided additional
financial support to ISFGS for this publication.
Publisher Copyright:
Copyright © 2022. Published by Elsevier Inc.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - BACKGROUND: Understanding the extent of tumor spread to local lymph nodes is critical to managing early-stage gastric cancer. Recently, fluorescence imaging with indocyanine green has been used to identify and characterize sentinel lymph nodes during gastric cancer surgery, but no published guidelines exist. We sought to identify areas of consensus among international experts in the use of fluorescence imaging with indocyanine green for mapping sentinel lymph nodes during gastric-cancer surgery. METHODS: In this 2-round, online Delphi survey, 27 international experts voted on 79 statements pertaining to patient preparation and contraindications to fluorescence imaging with indocyanine green during gastric cancer surgery; indications; technical aspects; advantages/disadvantages and limitations; and training and research. Methodological steps were adopted during survey design to minimize bias. RESULTS: Consensus was reached on 61 of 79 statements, including giving single injections of indocyanine green into each of the 4 quadrants peritumorally, administering indocyanine green on the same day as surgery, injecting a total of 1 to 5 mL of 5 mg/mL indocyanine green, injecting endoscopically into submucosa, and repeating indocyanine green injections a second time if sentinel lymph node visualization remains inadequate. Consensus also was reached that fluorescence imaging with indocyanine green is an acceptable single-agent modality for sentinel lymph node identification and that the sentinel lymph node basin method is preferred. However, sentinel lymph node dissection should be limited to T1 gastric cancer and tumors ≤4 cm in diameter, and further research is necessary to optimize the technique and render fluorescence-guided sentinel lymph nodes dissection acceptable for routine clinical use. CONCLUSION: Although considerable consensus was achieved, further research is necessary before this technology should be used in routine practice.
AB - BACKGROUND: Understanding the extent of tumor spread to local lymph nodes is critical to managing early-stage gastric cancer. Recently, fluorescence imaging with indocyanine green has been used to identify and characterize sentinel lymph nodes during gastric cancer surgery, but no published guidelines exist. We sought to identify areas of consensus among international experts in the use of fluorescence imaging with indocyanine green for mapping sentinel lymph nodes during gastric-cancer surgery. METHODS: In this 2-round, online Delphi survey, 27 international experts voted on 79 statements pertaining to patient preparation and contraindications to fluorescence imaging with indocyanine green during gastric cancer surgery; indications; technical aspects; advantages/disadvantages and limitations; and training and research. Methodological steps were adopted during survey design to minimize bias. RESULTS: Consensus was reached on 61 of 79 statements, including giving single injections of indocyanine green into each of the 4 quadrants peritumorally, administering indocyanine green on the same day as surgery, injecting a total of 1 to 5 mL of 5 mg/mL indocyanine green, injecting endoscopically into submucosa, and repeating indocyanine green injections a second time if sentinel lymph node visualization remains inadequate. Consensus also was reached that fluorescence imaging with indocyanine green is an acceptable single-agent modality for sentinel lymph node identification and that the sentinel lymph node basin method is preferred. However, sentinel lymph node dissection should be limited to T1 gastric cancer and tumors ≤4 cm in diameter, and further research is necessary to optimize the technique and render fluorescence-guided sentinel lymph nodes dissection acceptable for routine clinical use. CONCLUSION: Although considerable consensus was achieved, further research is necessary before this technology should be used in routine practice.
UR - http://www.scopus.com/inward/record.url?scp=85142940796&partnerID=8YFLogxK
U2 - 10.1016/j.surg.2022.06.036
DO - 10.1016/j.surg.2022.06.036
M3 - Article
C2 - 36427927
AN - SCOPUS:85142940796
VL - 172
SP - S29-S37
JO - Surgery
JF - Surgery
SN - 0039-6060
IS - 6
ER -
