Intraoperative Tumor Identification During Laparoscopic Distal Gastrectomy: a Novel Fluorescent Clip Marking Versus Metal Clip Marking and Intraoperative Gastroscope

Background In complete laparoscopic distal gastrectomy, the gastric resection line is difficult to determine due to a lack of tactile sensation. The use of intraoperative gastroscopy and intraoperative radiography has been reported, but the burden on personnel and technical complexity present impedi...

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Published in:Journal of gastrointestinal surgery 2022-06, Vol.26 (6), p.1132-1139
Main Authors: Hara, Keigo, Ryu, Shunjin, Okamoto, Atsuko, Kitagawa, Takahiro, Marukuchi, Rui, Ito, Ryusuke, Nakabayashi, Yukio
Format: Article
Language:English
Subjects:
Aqueous solutions
Cancer research
Cancer surgery
Coloring Agents
Dissection
Endoscopy
Gastrectomy
Gastric cancer
Gastroenterology
Gastrointestinal surgery
Gastroscopes
Gastroscopy
Humans
Laparoscopy
Lymphatic system
Medicine
Medicine & Public Health
Original Article
Retrospective Studies
Statistical analysis
Stomach Neoplasms - diagnostic imaging
Stomach Neoplasms - surgery
Surgery
Surgical Instruments
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Summary:Background In complete laparoscopic distal gastrectomy, the gastric resection line is difficult to determine due to a lack of tactile sensation. The use of intraoperative gastroscopy and intraoperative radiography has been reported, but the burden on personnel and technical complexity present impediments. In our department, based on lesion extent determined with preoperative gastroscopy, a fluorescent clip is used to mark the oral side of the lesion, which is resected after confirmation with a fluorescent laparoscopic system. In this study, we investigated the efficacy of fluorescent clip marking (FCM) in achieving an accurate resection line and reducing the operative time. Methods Fifty-six patients with gastric cancer who underwent complete laparoscopic distal gastrectomy from January 2018 to March 2021 were divided into two groups: the FCM group ( n = 32) and the conventional metal clip marking and intraoperative gastroscopy (MCMG) group ( n = 24). Short-term outcomes, including the resection margins, gastric resection time, and operative time, were compared and examined. Results The fluorescent clips were visible in all cases, and all stumps were negative according to permanent preparations. The operative times for FCM and MCMG were 350 (216–533) vs. 373.5 (258–651) min, respectively, with no significant difference ( p = 0.316), while the gastric resection times were 636.5 (321–2572) vs. 1457.5 (843–4973) s, respectively, and were significantly shorter in the FCM group ( p < 0.0001). Conclusions FCM shortened the gastric resection time and could possibly shorten the operative time. FCM is feasible and safe and can potentially be used as a tumor-marking agent to determine accurate surgical resection lines. Clinical Trial Registration Examination of Gastric Cancer, Research Ethics Committee of the Kawaguchi Municipal Medical Centre (Saitama, Japan), approval number: 2019-33. https://kawaguchi-mmc.org/wp-content/uploads/clinicalresearch-r02.pdf
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-021-05208-6