Effect of indocyanine green near-infrared light imaging technique guided lymph node dissection on short-term clinical efficacy of minimally invasive radical gastric cancer surgery: a meta-analysis

Abstract

Objective: In recent years, the utilization of indocyanine green near-infrared (ICG NIR) light imaging-guided lymph node dissection in the context of minimally invasive radical gastric cancer has emerged as a novel avenue for investigation. The objective of this study was to assess the influence of employing this technique for guiding lymph node dissection on the short-term clinical outcomes of minimally invasive radical gastric cancer surgery.

Methods: The present study conducted a comprehensive search for short-term clinical outcomes, comparing the group undergoing ICG NIR light imaging-guided lymph node dissection with the control group, by thoroughly examining relevant literature from the inception to July 2023 in renowned databases such as PubMed, Embase, Web of Science, and Cochrane Library. The primary endpoints encompassed postoperative complications, including abdominal infection, abdominal bleeding, pneumonia, anastomotic fistula, and overall incidence of complications (defined as any morbidity categorized as Clavien-Dindo class I or higher within 30 days post-surgery or during hospitalization). Additionally, secondary outcome measures consisted of the time interval until the initiation of postoperative gas and food intake, as well as various other parameters, namely postoperative hospital stay, operative time, intraoperative blood loss, total number of harvested lymph nodes, and the number of harvested metastatic lymph nodes. To ensure methodological rigor, the Cochrane Collaboration Risk of Bias Tool and the Newcastle-Ottawa Scale (NOS) were employed to assess the quality of the included studies, while statistical analyses were performed using Review Manager 5.4 software and Stata, version 12.0 software.

Results: A total of 19 studies including 3103 patients were ultimately included (n=1276 in the ICG group and n=1827 in the non-ICG group). In this meta-analysis, the application of ICG near-infrared light imaging in minimally invasive radical gastric cancer surgery effectively improved the occurrence of postoperative Clavien-Dindo grade II or higher complications in patients (RR=0.72, 95% CI 0.52 to 1.00) with a statistically significant P=0.05; in reducing intraoperative blood loss and shortening While reducing intraoperative blood loss and shortening postoperative hospital stay, it could ensure the thoroughness of lymph node dissection in minimally invasive radical gastric cancer surgery (MD=5.575, 95% CI 3.677-7.473) with significant effect size (Z=5.76, p<0.00001).

Conclusion: The utilization of indocyanine green near-infrared light imaging technology in the context of minimally invasive radical gastric cancer surgery demonstrates notable efficacy in mitigating the occurrence of postoperative complications surpassing Clavien-Dindo grade II, while concurrently augmenting both the overall quantity of lymph node dissections and the identification of positive lymph nodes, all the while ensuring the preservation of surgical safety. Furthermore, the implementation of this technique proves particularly advantageous in the realm of robotic-assisted radical gastric cancer surgery, thus bearing significance for enhancing the short-term prognostic outcomes of patients.

Keywords: gastric cancer resection; indocyanine green; laparoscopy; lymph node dissection; robotics.

Figure 1

Literature filtering process.

Figure 2

Forest plot assessment of short-term postoperative prognosis in the ICGFL group versus the non-ICGFL group. (A) total postoperative complication rate; (B) complication rate for Clavien-Dindo classification grade II or higher.

Figure 3

Forest plot assessment of short-term postoperative prognostic outcomes in the ICGFL and non-ICGFL groups. (A-F) in order of postoperative abdominal infection, abdominal bleeding, pneumonia, anastomotic fistula, postoperative gastric emptying disorder, and postoperative complications of concomitant intestinal obstruction.

Figure 4

Forest plots to assess the surgical and postoperative recovery in the ICG and non-ICG groups. (A–E) are operation time, intraoperative blood loss, total number of lymph nodes dissected, total number of metastatic lymph nodes dissected, and postoperative hospital stay.

Figure 5

Sensitivity analysis of each group included in the study regarding surgery and postoperative recovery in the ICG group versus the non-ICG group. (A–E) in order of surgery time, intraoperative blood loss, total number of lymph nodes cleared, total number of metastatic lymph nodes cleared, and postoperative hospital stay.

Figure 6

Forest plot assessment of recovery of first postoperative gas in the ICGFL group versus the non-ICGFL group.

Figure 7

Forest plot assessment of time to first postoperative fluid intake in the ICG and non-ICG groups.

Figure 8

Results of subgroup analysis based on the correlation between laparoscopic and robotic minimally invasive surgical approaches. (A–E) in order of operative time, intraoperative blood loss, total number of lymph nodes cleared, number of metastatic lymph nodes cleared, and postoperative hospital stay.

Figure 9

Results of subgroup analysis based on the extent of gastrectomy. (A–E) in order of operative time, intraoperative blood loss, total number of lymph nodes dissected, number of metastatic lymph nodes dissected, and postoperative hospital stay.

Figure 10

Funnel plot and Trim method to assess each outcome effect size for short-term postoperative prognosis. (A–H) in order of total complications, Clavien-Dindo grade II or higher complication rate, postoperative abdominal infection, abdominal bleeding, pneumonia, anastomotic fistula, postoperative gastric emptying disorder, and postoperative complication of intestinal obstruction.

Figure 11

Funnel plot and Trim method to assess the outcome effect sizes for surgery and postoperative recovery. (A–G) in order of surgery time, intraoperative blood loss, total number of lymph nodes cleared, total number of metastatic lymph nodes cleared, postoperative hospitalization time, postoperative time to first gas, and postoperative time to first fluid intake.