초록접수 현황
| 16F-245 | 구연 발표 |
Feasibility Study on the Near-infrared Image-guided Upper Mediastinal Lymph Node dissection for Esophageal Squamous Cell Carcinoma
Jee Won Suh, Seokkee Lee, kyoung Sik Narm, Chang Young Lee, Jin Gu Lee, Hyo Chae Paik, Kyung Young Chung, Dae Joon Kim
Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Background : Upper mediastinal LN dissection is a key step in curative surgery for ESCC. We introduced the NIR image-guided technique to discover the LNs at high risk of metastasis, and to confirm the complete clearance of the upper mediastinal LN.
Methods : The patients with clinical T1 ESCC in mid-, or lower esophagus who showed no upper mediastinal LN metastasis based on chest CT and PET-CT were enrolled. A day before the operation, ICG was injected into submucosal layer at 4 quadrants of a primary lesion under EGD. During upper MLND, SN was identified using the Firefly system. After the operation, all LNs along RLNs were classified into ICG+ or ICG- nodes under the Firefly system.
Results : Total 29 patients were enrolled, and there was no adverse event related to injection of ICG. The SN could be identified in 25 patients, and 6 of them showed LN metastasis in frozen section. LN metastasis was found along right RLN chain in 4 patients, and left in 2 patients for whom the additional neck dissection was carried out. After dissection of the specimen under the Firefly system, we retrieved 168 ICG+ nodes (mean 5.8 per patient) along both RLN chains, 95 ICG+ nodes (mean 3.3 per patient) along right RLN chain, and 73 ICG+ nodes (mean 2.5 per patient) along left RLN chain. Sensitivity, specificity, positive predictive value, and negative predictive value were 75.0%, 51.9%, 3.6%, 98.9% in both RLN chains, 100%, 42.0%, 4.2%, 100% in right RLN chains, and 50%, 60.6%, 2.7%, 98.2% in left RLN chain.
Conclusion : Our data suggests that the NIR technique could identify the LN at high risk of metastasis which was not identified in preoperative studies, and we might assure the complete clearance of LNs along RLN chains if there is no ICG+ node in the operating field.
Methods : The patients with clinical T1 ESCC in mid-, or lower esophagus who showed no upper mediastinal LN metastasis based on chest CT and PET-CT were enrolled. A day before the operation, ICG was injected into submucosal layer at 4 quadrants of a primary lesion under EGD. During upper MLND, SN was identified using the Firefly system. After the operation, all LNs along RLNs were classified into ICG+ or ICG- nodes under the Firefly system.
Results : Total 29 patients were enrolled, and there was no adverse event related to injection of ICG. The SN could be identified in 25 patients, and 6 of them showed LN metastasis in frozen section. LN metastasis was found along right RLN chain in 4 patients, and left in 2 patients for whom the additional neck dissection was carried out. After dissection of the specimen under the Firefly system, we retrieved 168 ICG+ nodes (mean 5.8 per patient) along both RLN chains, 95 ICG+ nodes (mean 3.3 per patient) along right RLN chain, and 73 ICG+ nodes (mean 2.5 per patient) along left RLN chain. Sensitivity, specificity, positive predictive value, and negative predictive value were 75.0%, 51.9%, 3.6%, 98.9% in both RLN chains, 100%, 42.0%, 4.2%, 100% in right RLN chains, and 50%, 60.6%, 2.7%, 98.2% in left RLN chain.
Conclusion : Our data suggests that the NIR technique could identify the LN at high risk of metastasis which was not identified in preoperative studies, and we might assure the complete clearance of LNs along RLN chains if there is no ICG+ node in the operating field.
책임저자: Dae Joon Kim
Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
발표자: Jee Won Suh, E-mail : suh_1225@yuhs.ac