| Currently,standard D2 radical surgery is the only way to cure gastric cancer.The most common way of gastric cancer metastasis is lymphatic metastasis.Thorough and effective removal of a sufficient number of lymph nodes will greatly help the prognosis of gastric cancer.Since most lymph nodes are difficult to distinguish from adipose tissue under laparoscopy,how to accurately remove the lymph nodes has become the focus and difficulty in radical gastric cancer surgery.With the continuous innovation of surgical technology and equipment,as well as the improvement of people's understanding of tumor biological behavior,intraoperative lymphatic navigation technology based on different tracers has important clinical significance for the exposure of lymph nodes and the protection of radical treatment.It has attracted wide attention from clinicians.How to use the tracer rationally to ensure the radical cure of the operation and minimize unnecessary injuries during the operation is the core point of the lymphatic navigation technology.At present,the most studied and most widely used tracers in clinical applications include indocyanine green(ICG)and carbon nanoparticles,but there are still some controversies and research gaps in clinical applications,and the supplement and discussion of clinical research data are urgently needed.Indocyanine green(ICG)is a water-soluble dye with strong absorption in the near-infrared spectrum,low toxicity,and rapid excretion.When ICG is used for intraoperative tracing under near-infrared light irradiation,the stained lymph and blood vessels appear green,which can be clearly distinguished from the surrounding unstained tissue,so that the surgeon can complete the sentinel lymph node of early gastric cancer under laparoscopic surgery.Labeling and navigation of lymphatic drainage in advanced gastric cancer.Some clinical studies have found that the application of ICG fluorescence imaging in laparoscopic radical gastric cancer surgery is beneficial to gastric lymph node dissection,can increase the number of lymph nodes detected,and does not increase the operation time and postoperative complications.It has potential clinical applications value.However,worldwide,the application of ICG-labeled near-infrared imaging fluorescence laparoscopic technology in laparoscopic radical gastric cancer surgery is still in the stage of exploration and experience accumulation.The sensitivity and specificity of its tracer,long-term efficacy,and use the existing problems still lack complete evidence-based medical evidence and uniform and feasible operating norms.Carbon nanoparticles is currently the most widely used and in-depth researched carrier for peripheral lymph node imaging and lymphatic targeting chemotherapy in gastric cancer in my country.Based on the anatomical differences of the vessels and the physical characteristics of carbon nanoparticles,when carbon nanoparticles are injected into the para-tumor sites,they do not pass through the capillary,but rapidly drain into the lymphatic capillaries to the surrounding lymph vessels and lymph nodes.The carbon nanoparticles entering the lymphatic circulation are further recognized and swallowed by macrophages,resulting in a large number of carbon particles staying in the lymph nodes,causing the lymph nodes to be darkened,which is easy to identify during the operation,so as to achieve the purpose of intraoperative lymphatic drainage navigation,which is used in lymphatic tracing Its safety and advantages have been continuously confirmed by many studies.However,there are also opinions that there is no effective evidence for the affinity of carbon nanoparticles to metastatic lymph nodes,and further clinical research observations and proofs are still needed.The author's team has routinely carried out navigation laparoscopic radical gastric cancer surgery using ICG/carbon nanoparticles since 2016,and conducted multi-angle practice,observation and discussion on the gaps and controversies of the above two tracers in clinical research.First,we evaluated the safety and effectiveness of ICG and carbon nanoparticles-guided fluorescence tracer technology in laparoscopic radical gastric cancer surgery.Compared with conventional laparoscopic radical gastric cancer surgery,our research data shows that ICG and carbon nanoparticles-guided laparoscopic radical gastric cancer surgery can improve the lymph nodes of laparoscopic radical gastric cancer surgery without affecting the short-term and long-term prognosis of patients.Secondly,this study found that the two tracers were compared horizontally on the lymph node dissection effects in various pathological stages and various radical gastric cancer surgical procedures.Although the overall difference was not statistically significant,the number of lymph nodes detected at each station was compared in detail with the detected results.It is found that carbon nanoparticles are more helpful than ICG to increase the number of dissections of the fifth station of the radical whole stomach,the number of dissections of the first station of the radical proximal stomach,and the total number of dissections of the radical distal gastric lymph nodes,suggesting different indications.There are differences in the navigation effect of the tracer on the lymph nodes of different stations in different gastric cancer surgical procedures.Based on this result,and because the pathologist is responsible for the lymph node sorting of gastric cancer resection specimens in traditional clinical practice,we further explored whether the lymph node sorting performed by surgeons who are more familiar with local anatomy is important for pathologists to perform lymph node sorting.The number of detections and the positive rate are helpful.We found that this approach can help increase the number of lymph node dissections for stage I gastric cancer and radical total gastrectomy under 3D laparoscopic carbon nanoparticles navigation.In summary,this study conducted a series of clinical research work using ICG and carbon nanoparticles,and found that both tracers have the same good tracing effect,which improves the detection rate of lymph nodes in postoperative pathology;horizontal comparison revealed that different tracers have differences in the navigation effect of lymph nodes at different stations in different gastric cancer surgical procedures,suggesting that in clinical practice,individualized tracing strategies should be developed according to the patient's condition;the lymph node sorting performed by the surgeon can further optimize the detection of lymph nodes,suggesting that the standard operating procedures of laparoscopic gastric cancer surgery and the provision of professional tracer injection and lymph node sorting teams will help to further improve the therapeutic effect of laparoscopic radical gastric cancer surgery under navigation,which has important clinical significance. |
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