Mo1265 Echosonographic Characteristics of Regional Lymph Nodes Are Predictive of Malignant Spread in Esophageal Cancer

Abstract Background Minimally invasive approach to esophageal cancer has been accepted as the standard of care in many centers. Nontheless, some technical difficulties are encountered during surgery. A proper vascularization of the gastric tube is mandatory to avoid the dreadful complication of a leak or of gastric conduit necrosis. On the other hand, there is controversy on the identification of sentinel lymph node in early esophageal cancer and on the extent of lymphadenectomy in locally advanced tumours. Indocyanine green (ICG) is a sterile, anionic, water-soluble but relatively hydrophobic, tricarbocyanine molecule, which is bound to plasma proteins when intravenously injected. It is extracted by the liver appearing in the bile around 8 minutes after injection. When injected outside the blood vessels, ICG reaches the nearest lymph node within 15 minutes and after 1 to 2 hours it binds to the regional lymph nodes. The usual dose of ICG is 0.1 - 0.5mg/mL/kg. ICG becomes fluorescent once excited with near-infrared (NIR) light at about 820 nm. The fluorescence released by ICG may be detected using specially developed cameras. Methods A systematic review of the literature of ICG in esophageal surgery was carried on February 2018 using the following terms: esophagus, indocyanine green, ICG, surgery, angiography, lymph node, and combinations of the above. Results The technique of ICG angiography for vascular assessment of the gastroepiploic arcade and gastric conduit is explained and the published results are review. The use of ICG for the evaluation of sentinel lymph node in early esophageal cancer and of lymph node mapping for regional lymph nodes is explained and current evidence is reviewed. Conclusion ICG use in esophageal surgery is still a novel and promising technique. It could help to reduce anastomotic leak by means of vascular assessment of the gastric conduit, locate lymph nodes out of the usual fields of lymphadenectomy and locate the sentinel lymph node in early esophageal cancer Disclosure All authors have declared no conflicts of interest.

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Safety and feasibility of near-infrared image-guided lymphatic mapping of regional lymph nodes in esophageal cancer

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2016.04.025 ◽

2016 ◽

Vol 152 (2) ◽

pp. 546-554 ◽

Cited By ~ 27

Author(s):

Krista J. Hachey ◽

Denis M. Gilmore ◽

Katherine W. Armstrong ◽

Sean E. Harris ◽

Jason L. Hornick ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Nodes ◽

Near Infrared ◽

Lymphatic Mapping ◽

Infrared Image ◽

Regional Lymph Nodes ◽

Image Guided

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Clinical Effect of the Preservasion of Cardiac Branch of the Right Vagal Nerve on the Post-Operative Condition after the Resection of Esophageal Cancer with 3-Regional Lymph Nodes Dissection

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.25.2446 ◽

1992 ◽

Vol 25 (9) ◽

pp. 2446-2446 ◽

Cited By ~ 2

Author(s):

Yoshiaki Kajiyama ◽

Masahiko Tsurumaru ◽

Yoshimasa Ono ◽

Harushi Udagawa ◽

Goro Watanabe ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Nodes ◽

Clinical Effect ◽

Vagal Nerve ◽

Regional Lymph Nodes ◽

Lymph Nodes Dissection ◽

The Right

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Accuracy of EUS-FNA for distant regional lymph nodes in the initial staging of esophageal cancer (EC).

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.15_suppl.4064 ◽

2015 ◽

Vol 33 (15_suppl) ◽

pp. 4064-4064

Author(s):

Yusuke Shimodaira ◽

Elena Elimova ◽

Hironori Shiozaki ◽

Roopma Wadhwa ◽

Nikolaos Charalampakis ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Nodes ◽

Regional Lymph Nodes ◽

Initial Staging

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Utility of PET-CT CMR after neoadjuvant chemotherapy with DCF for esophageal cancer as a predictive factor of recurrence.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.434 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 434-434

Author(s):

Suzuki Kosuke ◽

Shibata Tomotaka ◽

Nishiki Kohei ◽

Fumoto Shoichi ◽

Hirarsuka Takahiro ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Lymph Nodes ◽

Accumulation Rate ◽

Clinical Stage ◽

Operation Time ◽

Regional Lymph Nodes ◽

Pet Ct ◽

Significant Difference

434 Background: PET-CT is considered as standard modality for evaluating metastasis of esophageal cancer before treatment. On the other hand, it is unclear whether PET-CT CMR (complete metabolic response) could be useful for assessment after neoadjuvant chemotherapy. To clarify the utility of PET-CT CMR as an adequate modality of prediction for recurrence after neoadjuvant chemotherapy with DCF for esophageal cancer. Methods: Fifty-eight cases of esophageal cancer (cStageII-IVa) who received the esophagectomy with neoadjuvant chemotherapy of DCF since June 2013 in Oita University. We evaluated the clinicopathological factors, RFS and OS between CMR group (n=22, 38%) and non-CMR group (n=36, 62%). Results: In the clinical stage before chemotherapy, T-factor was higher in the non-CMR group (p = 0.044), but there were no significant differences of lymph node metastasis (p = 0.27) and stage (p = 0.94) between the two groups. There was no significant difference of the SUV max (16.4 ± 6.5 vs 15.7 ± 6.5, p = 0.98) of the main lesion before chemotherapy and the FDG accumulation rate of lymph nodes (14 cases (63.6%) vs 21 cases) (58.3%), p = 0.69) between the two groups. There were no significant differences of the surgical procedure, lymph node dissection area, number of harvested lymph nodes, amount of bleeding, operation time, curability, and intra/post-operative complications between the two groups. There were 5 cases (15%) with postoperative recurrence in the CMR group (lung 1 case, extra-regional lymph nodes 3 cases, bone 1 case), 17 cases (47%) in the non-CMR group (local 4 cases, lung 3 cases, livers 5 cases, extra regional lymph nodes 6 cases, bone 4 cases, pleura 2 cases), but there was no significant difference between the two groups (p = 0.062). There were significant differences between the two groups for 3-year RFS (81.3 vs 65.3 months, p=0.021) and 3-year OS (93.8 vs 61.6 months, p=0.011). Conclusions: PET-CR CMR could not predict recurrence at present. PET-CR CMR cases had better prognosis compared to non-CMR cases in terms of 3-year RFS and 3-years OS.

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