Safety and efficacy of indocyanine green near-infrared fluorescent imaging-guided lymph node dissection during robotic gastrectomy for gastric cancer: a systematic review and meta-analysis

• Published in: Minimally invasive therapy and allied technologies Vol. ahead-of-print; no. ahead-of-print; pp. 1 - 9
• Main Authors: Zhang, Zhenyu, Deng, Chun, Guo, Zhi, Liu, Yang, Qi, Hengduo, Li, Xiaojun
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 03.10.2023
• Subjects: Blood Loss, Surgical; Coloring Agents; Gastrectomy - methods; gastric cancer; Humans; Indocyanine Green; lymph node; Lymph Node Excision - methods; Lymph Nodes - pathology; meta-analysis; Postoperative Complications; robotic gastrectomy; Robotic Surgical Procedures; Stomach Neoplasms - surgery; meta-analysis; robotic gastrectomy; Indocyanine green; gastric cancer; lymph node
• ISSN: 1364-5706; 1365-2931; 1365-2931
• DOI: 10.1080/13645706.2023.2165415

In Asia, particularly, robotic gastrectomy has grown in popularity as a treatment for stomach cancer. Indocyanine green (ICG) and near-infrared (NIR) fluorescent imaging technology has been reported for robotic gastrectomy. However, the clinical value still should be further evaluated. In this meta-analysis, we investigated the safety and efficacy of ICG near-infrared fluorescent imaging-guided lymph node (LN) dissection during robotic gastrectomy. Through July 2022, systematic searches of PubMed, Embase, Web of Science, and the Cochrane Library were conducted to find studies comparing ICG fluorescence imaging with conventional treatment in patients with gastric cancer. The current meta-analysis was performed according to the preferred reporting items for systematic review and meta-analysis guidelines. A pooled analysis was performed for the available data regarding the number of lymph node dissections, other operative outcomes and postoperative complications. R studio software 4.2.2 was used for this meta-analysis. This analysis includes five studies with a total of 312 gastric cancer patients (128 in the ICG group and 184 in the non-ICG group). In this meta-analysis, the number of retrieved LNs in the ICG group was significantly higher (weighted mean difference [WMD] = 8.80, 95% confidence intervals [CI]: 4.37-13.22, p < 0.05) than that in the non-ICG group with moderate heterogeneity (p < 0.0001, I 2 =53.3%). Intraoperative blood loss and postoperative complications were all comparable and without significant heterogeneity. Additionally, ICG near-infrared fluorescent imaging was associated with a reduced operative time (WMD= −11.85, 95% CI: −22.40 to −1.30, p < 0.05) with low heterogeneity (p = 0.027, I 2 = 2.1%). ICG near-infrared fluorescent imaging-guided lymphadenectomy was considered to be safe and effective in robotic gastrectomy. ICG was used to increase the number of LNs harvested while reducing operative time without increasing intraoperative blood loss or postoperative complications.