Identification of the Lymphatic Drainage Pattern of Esophageal Cancer with Near-Infrared Fluorescent Imaging

Abstract

Objective: Nodal status is one of the most important long-term prognostic factors for esophageal cancer. The aim of this study was to evaluate the ability of near-infrared (NIR) light fluorescent imaging to identify the lymphatic drainage pattern of esophageal cancer.

Methods: Patients with distal esophageal cancer or esophagogastric junction cancer scheduled for esophagectomy were enrolled in this study. Before surgery, an endoscopy was performed with submucosal injection of 2 cc of indocyanine green (ICG) around the tumor. Real-time NIR images from the surgical field were obtained for each patient to visualize the lymphatic ICG drainage.

Results: A total of nine patients were included in this study. Ivor Lewis esophagectomy was performed in all cases. ICG drainage was visualized to first drain along the left gastric nodes in eight patients (88.9%) and toward the diaphragmatic nodes in one patient (11.1%). The median number of resected nodes was 32. Three patients (33.3%) presented nodal involvement. All of them had positive nodes in the first nodal station identified with ICG.

Conclusions: Evaluation of the lymphatic drainage pattern with real-time NIR light fluorescent technique is feasible. Distal and esophagogastric junction tumors showed to drain first in the left gastric nodes in most of the cases.

Keywords: esophageal cancer; lymphatic drainage; near-infrared imaging.

Conflict of interest statement

Dr. Molena has been a speaker for the educational meeting organized by Novadaq, Inc. For all other authors, no competing financial interests exist.

Figures

FIG. 1.

Endoscopic injection of ICG around the tumor. ICG, indocyanine green.

FIG. 2.

NIR imaging with detection of ICG along the left gastric artery. ICG, indocyanine green; NIR, near-infrared.

FIG. 3.

NIR imaging with detection of ICG in diaphragmatic nodes. ICG, indocyanine green; NIR, near-infrared.