Mapping the lymphatic drainage pattern of esophageal cancer with near-infrared fluorescent imaging during robotic assisted ivor lewis esophagectomy - The ESOMAP trial

Background Nodal status is one of the most important prognostic factors for esophageal cancer. The lymphatic drainage pattern of cardia cancer is incompletely understood and there is still debate how radical the lymphadenectomy needs to be. The aim of this study is to evaluate the ability of near-infrared (NIR) light fluorescent imaging to identify the lymphatic drainage pattern of esophageal cancer and to compare the lymph node yield to our standardized robotic cohort.

Methods Patients with AEG I or II tumors scheduled for a robotic Ivor Lewis esophagectomy were enrolled in this study. Before surgery, an endoscopy was performed with submucosal injection of 2 cc of ICG around the tumor. Real-time NIR images from the surgical field will be obtained for each patient to visualize the lymphatic ICG drainage. A correlation will be performed with histopathological work-up of these lymph nodes to prove feasibility of the technique.

Results From 12/2019-02/2021 twelve patients were included in the study. Demographic, oncological data and postoperative complications are shown in [Abb 1] in addition to a comparison of the study population to our standardized RAMIE cases. No side effects from the ICG were reported. A total of 399 lymph nodes were resected(mean 33, range 17-57)compared to an average of 34.3 lymph nodes in the RAMIE group.

Conclusion Real-time NIR has shown to be an ideal and innovative diagnostic tool to determine the localization of AEG tumors and may be a valid tool to increase the lymph node yield in patient undergoing standardized RAMIE. If real-time NIR using ICG can safely identify positive lymph nodes is yet to be determined. We are currently performing molecular analyses to determine if ICG status shows a correlation with lymphangiogenesis. The ESOMAP protocol may lead to less postoperative complications and especially decrease the risk for an anastomotic leakage, as no patient in this group developed this complication.

Abb 1

Publication History

Article published online:
07 September 2021