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. 2023 Jul;37(7):5472-5481.
doi: 10.1007/s00464-023-10043-8. Epub 2023 Apr 12.

Fluorescence-based sentinel lymph node mapping and lymphography evaluation: results from the IHU-IRCAD-EAES EURO-FIGS registry

Andrea Picchetto #  1 , Lorenzo Cinelli #  2   3 , Elisa Bannone  2   4   5 , Gian Luca Baiocchi  6 , Salvador Morales-Conde  7   8 , Lorenzo Casali  9 , Giuseppe Spinoglio  10 , Christian Franzini  9 , Caterina Santi  9 , Giancarlo D'Ambrosio  11 , Catalin Copaescu  12 , Alessio Rollo  9 , Andrea Balla  13 , Pasquale Lepiane  13 , Alessandro M Paganini  11 , Paolo Detullio  9 , Silvia Quaresima  11 , Antonio Pesce  14 , Tartamella Luciano  9 , Giorgio Bianchi  9 , Jacques Marescaux  2 , Michele Diana  2   15   16   17
Affiliations

Fluorescence-based sentinel lymph node mapping and lymphography evaluation: results from the IHU-IRCAD-EAES EURO-FIGS registry

Andrea Picchetto et al. Surg Endosc. 2023 Jul.

Abstract

Background: The identification of metastatic lymph nodes is one of the most important prognostic factors in gastrointestinal (GI) cancers. Near-infrared fluorescence (NIRF) imaging has been successfully used in GI tumors to detect the lymphatic pathway and the sentinel lymph node (SLN), facilitating fluorescence image-guided surgery (FIGS) with the purpose to achieve a correct nodal staging. The aim of this study was to analyze the current results of NIRF SLN navigation and lymphography through data collected in the EURO-FIGS registry.

Methods: Prospectively collected data regarding patients and ICG-guided lymphadenectomies were analyzed. Additional analyses were performed to identify predictors of metastatic SLN and determinants of fluorescence positivity and nodal metastases outside the boundaries of standard lymphadenectomies.

Results: Overall, 188 patients were included by 18 surgeons from 10 different centers. Colorectal cancer was the most reported pathology (77.7%), followed by gastric (19.1%) and esophageal tumors (3.2%). ICG was injected with higher doses (p < 0.001) via extraparietal side (63.3%), and with higher volumes (p < 0.001) via endoluminal side (36.7%). Overall, NIRF SLN navigation was positive in 75.5% of all cases and 95.5% of positive SLNs were retrieved, with a metastatic rate of 14.7%. NIRF identification of lymph nodes outside standard lymphatic stations occurred in 52.1% of all cases, 43.8% of which were positive for metastatic involvement. Positive NIRF SLN identification was an independent predictor of metastasis outside standard lymphatic stations (OR = 4.392, p = 0.029), while BMI independently predicted metastasis in retrieved SLNs (OR = 1.187, p = 0.013). Lower doses of ICG were protective against NIRF identification outside standard of care lymphadenectomy (OR = 0.596, p = 0.006), while higher volumes of ICG were predictive of metastatic involvement outside standard of care lymphadenectomy (OR = 1.597, p = 0.001).

Conclusions: SLN mapping helps identifying potentially metastatic lymph nodes outside the boundaries of standard lymphadenectomies. The EURO-FIGS registry is a valuable tool to share and analyze European surgeons' practices.

Keywords: Colorectal cancer; EURO-FIGS; Fluorescence-guided surgery; Near-infrared fluorescence imaging; Sentinel lymph node mapping.

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