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Superior lymph node harvest by fluorescent lymphography during minimally invasive gastrectomy for gastric cancer patients with high body mass index

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Abstract

Background

Fluorescent lymphography (FL) using indocyanine green (ICG) allows for the visualization of all draining lymph nodes (LNs), thereby increasing LN retrieval. However, no studies have assessed the efficacy of FL in high body mass index (BMI) gastric cancer patients, even as LN yield decreases with increasing BMI in gastrectomy. This study aimed to investigate the influence of FL on LN retrieval in high BMI gastric cancer patients.

Methods

Gastric cancer patients who underwent laparoscopic or robotic gastrectomies from 2013 to 2021 were included. Patients were classified into two groups, with FL (FL group) or without FL (non-FL group). The effect of FL on LN retrieval was assessed by BMI. Inverse probability of treatment weighting (IPTW) was used to ensure comparability between groups.

Results

Retrieved LN number decreased as BMI increased regardless of FL application (P < 0.001). According to the IPTW analysis, the mean retrieved LN number was significantly higher in the FL group (48.4 ± 18.5) than in the non-FL group (39.8 ± 16.3, P < 0.001), irrespective of BMI. The FL group exhibited a significantly higher proportion of patients with 16 or more LNs (99.5%) than the non-FL group (98.1%, P < 0.001). The FL group also had a significantly higher proportion of patients with 30 or more LNs (86.6%) than the non-FL group (72.2%, P < 0.001). In both the normal and high-BMI patients, the FL group had a significantly larger percentage of patients with a higher nodal classification than the non-FL group.

Conclusion

FL resulted in more LN retrieval, even in high BMI patients. FL ensures accurate staging by maintaining the appropriate retrieved LN number in high BMI gastric cancer patients.

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Data availability

The data presented in this study are available upon request from the corresponding author.

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Acknowledgements

We acknowledge the assistance of Editage (www.editage.co.kr) for editing and reviewing this manuscript for English language usage.

Funding

Investigator Sponsored Research Program (ISR-2017–10924) and Covidien Private Limited (Medtronic).

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Authors and Affiliations

  1. Department of Surgery, Yonsei University College of Medicine, and Gastric Cancer Center, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea

    Ki-Yoon Kim, Jawon Hwang, Sung Hyun Park, Minah Cho, Yoo Min Kim, Hyoung-Il Kim & Woo Jin Hyung

  2. Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea

    Ki-Yoon Kim, Jawon Hwang, Sung Hyun Park, Minah Cho, Yoo Min Kim, Hyoung-Il Kim & Woo Jin Hyung

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  1. Ki-Yoon Kim
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  2. Jawon Hwang
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  4. Minah Cho
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  5. Yoo Min Kim
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Correspondence to Woo Jin Hyung.

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Conflict of interest

This study was supported by a grant from the Investigator Sponsored Research Program (ISR-2017–10924) and Covidien Private Limited (Medtronic). The funding sources played no role in the design of this study and did not play any role in study execution, data analysis, data interpretation, or the decision to submit the results for presentation or publication. W.J.H. had full access to all data in the study and took responsibility for the integrity of the data and the accuracy of data analysis. W.J.H. is a stockholder and chief executive officer of Hutom. He received research grants from Medtronic and GC Pharma. He provided consultancy services to SK Hynix (Wuxi) outside of the submitted work. The other authors declare no conflicts of interest.

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Presentation: This work was presented at the 2022 Annual Meeting of KINGCA, Seoul, Republic of Korea, from September 1 to September 3, 2022.

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Kim, KY., Hwang, J., Park, S.H. et al. Superior lymph node harvest by fluorescent lymphography during minimally invasive gastrectomy for gastric cancer patients with high body mass index. Gastric Cancer 27, 622–634 (2024). https://doi.org/10.1007/s10120-024-01482-w

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