Safety And Efficacy Of Fluorescence Guided Radical Gastrectomy For Gastric Cancer

Objective: To explore the difference of clinical efficacy between fluorescence navigation laparoscopy and conventional laparoscopy in radical gastrectomy for gastric cancer,and to elaborate the safety and effectiveness of fluorescence navigation laparoscopy in radical gastrectomy for gastric cancer.Methods: The clinical data of 205 patients with laparoscopic radical gastrectomy in the Department of gastrointestinal surgery of the Affiliated Hospital of Qinghai University from September 2018 to December 2021 were retrospectively analyzed,and 160 patients were selected through the inclusion and exclusion criteria.The routine group was treated with laparoscopic radical gastrectomy,while the fluorescence group was treated with indocyanine green(ICG)labeled fluorescence imaging.The routine group and fluorescence group accounted for 80 cases respectively.The clinical data(age,sex,BMI,clinical stage,etc.)and surgical data(total operation time,lymph node dissection time,gastrointestinal reconstruction time,estimated intraoperative blood loss)of the two groups were compared and analyzed Postoperative pathological data(pathological stage,total number of lymph nodes obtained,total number of positive lymph nodes,distance from tumor to oral and anal cutting edge,degree of tumor differentiation,Borrmann classification,Lauren classification,nerve invasion and vascular invasion),Perioperative laboratory data(leukocyte count,neutrophil count,serum procalcitonin,C-reactive protein,serum albumin,serum total bilirubin,serum alkaline phosphatase,hemoglobin and platelet count on the 1st,3rd and 5th day after operation),Postoperative rehabilitation(first time out of bed,first exhaust time,first eating time,indwelling drainage tube time,total postoperative hospital stay)and postoperative complications(anastomotic leakage,anastomotic bleeding,abdominal infection,incision related complications,intestinal obstruction,pancreatic fistula,etc.).Results: In the fluorescence group,the average total number of lymph nodes was 37.00(29.00,48.00),the average number of positive lymph nodes was 7.00(2.00,16.00),and the average number of lymph nodes with diameter less than 5mm was 19.00(16.25,23.75);The average total number of lymph nodes obtained in the routine group was 32.00(26.00,40.00),the average number of positive lymph nodes was 4.00(0.25,9.75),and the average number of lymph nodes with diameter less than 5mm was 14.00(10.00,18.00).Among the three indexes,the fluorescence group was higher than the routine group,and the difference was statistically significant(P < 0.05).However,the number of lymph nodes with diameter ≥ 5mm was 16.00(12.00,20.00)in the fluorescence group and 17.00(13.00,20.00)in the routine group.There was no significant difference between the two groups(P > 0.05).There was no significant difference in the total operation time,estimated intraoperative bleeding and other intraoperative data,as well as postoperative recovery data such as the first time to get out of bed and the first time to eat;In addition,there was no significant difference between the two groups in the degree of tumor differentiation,Pt,PN,p TNM stage,Lauren’s classification,Borrmann’s classification,neurovascular invasion,distance from the tumor to the oral and anal margin,and postoperative complications(P > 0.05).Conclusion:Without prolonging the total operation time and increasing postoperative complications,fluorescence navigation technology has obvious advantages in guiding lymph node dissection.Fluorescence navigation radical gastrectomy is safe and effective in clinical application,which is worthy of popularization and study.