Near‐infrared fluorescence lymph node template region dissection plus backup lymphadenectomy in open radical cystectomy for bladder cancer using an innovative handheld device: A single center experience
Journal of Surgical Oncology, vol. 129, pp. 1325–1331
Abstract
BACKGROUND: The extent of pelvic lymphadenectomy (PLND) as part of radical cystectomy (RC) for bladder cancer (BC) remains unclear. Sentinel-based and lymphangiographic approaches could lead to reduced morbidity without sacrificing oncologic safety. OBJECTIVE: To evaluate the feasibility and diagnostic value of fluorescence-guided template sentinel region dissection (FTD) using a handheld near-infrared fluorescence (NIRF) camera in open radical cystectomy. DESIGN, SETTING, AND PARTICIPANTS: After peritumoral cystoscopic injection of indocyanine green (ICG) 21 patients underwent open RC with FTD due to BC between June 2019 and June 2021. Intraoperatively, the FIS-00 Hamamatsu Photonics® NIRF camera was used to identify and resect fluorescent template sentinel regions (FTRs) followed by extended pelvic lymphadenectomy (ePLND) as oncological back-up. OUTCOME MEASUREMENT AND STATISTICAL ANALYSIS: Descriptive analysis of positive and negative results per template region. RESULTS AND LIMITATIONS: FTRs were identified in all 21 cases. Median time (range) from ICG injection to fluorescence detection was 75 (55-125) minutes. On average (SD), 33.4 (9.6) lymph nodes were dissected per patient. Considering template regions as the basis of analysis, 67 (38.3%) of 175 resected regions were NIRF-positive, with 13 (7.4%) regions harboring lymph node metastases. We found no metastatic lymph nodes in NIRF-negative template regions. Outside the standard template, two NIRF-positive benign nodes were identified. CONCLUSION: The concept of NIRF-guided FTD proved for this group all lymph node metastases to be found in NIRF-positive template regions. Pending validation in a larger collective, resection of approximately 40% of standard regions may be sufficient and may result in less morbidity.
Authors 15
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Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung · University of Duisburg-Essen
Affiliation as printed
Department of Urology West German Cancer Center University Duisburg Essen, University Hospital Essen Essen Germany
German Cancer Consortium (DKTK) Heidelberg Germany
Department of Urology, West German Cancer Center, University Duisburg Essen, University Hospital Essen, Essen, Germany
German Cancer Consortium (DKTK), Heidelberg, Germany
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Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung · University of Duisburg-Essen
Affiliation as printed
Department of Nuclear Medicine West German Cancer Center University Duisburg Essen, University Hospital Essen Essen Germany
German Cancer Consortium (DKTK) Heidelberg Germany
Department of Nuclear Medicine, West German Cancer Center, University Duisburg Essen, University Hospital Essen, Essen, Germany
German Cancer Consortium (DKTK), Heidelberg, Germany
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Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung · University of Duisburg-Essen
Affiliation as printed
Department of Urology West German Cancer Center University Duisburg Essen, University Hospital Essen Essen Germany
German Cancer Consortium (DKTK) Heidelberg Germany
Department of Urology, West German Cancer Center, University Duisburg Essen, University Hospital Essen, Essen, Germany
German Cancer Consortium (DKTK), Heidelberg, Germany
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Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung · University of Duisburg-Essen
Affiliation as printed
Department of Urology West German Cancer Center University Duisburg Essen, University Hospital Essen Essen Germany
German Cancer Consortium (DKTK) Heidelberg Germany
Department of Urology, West German Cancer Center, University Duisburg Essen, University Hospital Essen, Essen, Germany
German Cancer Consortium (DKTK), Heidelberg, Germany
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Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung · University of Duisburg-Essen
Affiliation as printed
Department of Urology West German Cancer Center University Duisburg Essen, University Hospital Essen Essen Germany
German Cancer Consortium (DKTK) Heidelberg Germany
Department of Urology, West German Cancer Center, University Duisburg Essen, University Hospital Essen, Essen, Germany
German Cancer Consortium (DKTK), Heidelberg, Germany
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Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung · University of Duisburg-Essen
Affiliation as printed
Department of Urology West German Cancer Center University Duisburg Essen, University Hospital Essen Essen Germany
German Cancer Consortium (DKTK) Heidelberg Germany
Department of Urology, West German Cancer Center, University Duisburg Essen, University Hospital Essen, Essen, Germany
German Cancer Consortium (DKTK), Heidelberg, Germany
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Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung · University of Duisburg-Essen
Affiliation as printed
Department of Urology West German Cancer Center University Duisburg Essen, University Hospital Essen Essen Germany
German Cancer Consortium (DKTK) Heidelberg Germany
Department of Urology, West German Cancer Center, University Duisburg Essen, University Hospital Essen, Essen, Germany
German Cancer Consortium (DKTK), Heidelberg, Germany
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Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung · University of Duisburg-Essen
Affiliation as printed
Department of Urology West German Cancer Center University Duisburg Essen, University Hospital Essen Essen Germany
German Cancer Consortium (DKTK) Heidelberg Germany
Department of Urology, West German Cancer Center, University Duisburg Essen, University Hospital Essen, Essen, Germany
German Cancer Consortium (DKTK), Heidelberg, Germany
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Goethe University Frankfurt · University Hospital Frankfurt
Affiliation as printed
Dr. Senckenberg Institute of Pathology Goethe University Frankfurt, University Hospital Frankfurt Frankfurt am Main Germany
Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
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Semmelweis University · Goethe University Frankfurt · Essen University Hospital · University Hospital Frankfurt · Deutsches Konsortium für Translationale Krebsforschung · University of Duisburg-Essen
Affiliation as printed
Department of Urology Faculty of Medicine Semmelweis University Budapest Hungary
Department of Urology West German Cancer Center University Duisburg Essen, University Hospital Essen Essen Germany
Dr. Senckenberg Institute of Pathology Goethe University Frankfurt, University Hospital Frankfurt Frankfurt am Main Germany
German Cancer Consortium (DKTK) Heidelberg Germany
Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
Department of Urology, West German Cancer Center, University Duisburg Essen, University Hospital Essen, Essen, Germany
Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
German Cancer Consortium (DKTK), Heidelberg, Germany
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Fijs W. B. van Leeuwen Aachen Interventional Molecular Imaging Laboratory Department of Radiology Leiden University Medical Centre Leiden University Leiden Netherlands Department of Radiology, Leiden University Medical Center
Leiden University · Leiden University Medical Center
Affiliation as printed
Interventional Molecular Imaging Laboratory, Department of Radiology Leiden University Medical Centre Leiden University Leiden Netherlands
Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
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Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung · University of Duisburg-Essen
Affiliation as printed
Department of Nuclear Medicine West German Cancer Center University Duisburg Essen, University Hospital Essen Essen Germany
German Cancer Consortium (DKTK) Heidelberg Germany
Department of Nuclear Medicine, West German Cancer Center, University Duisburg Essen, University Hospital Essen, Essen, Germany
German Cancer Consortium (DKTK), Heidelberg, Germany
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Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung · University of Duisburg-Essen
Affiliation as printed
Department of Urology West German Cancer Center University Duisburg Essen, University Hospital Essen Essen Germany
German Cancer Consortium (DKTK) Heidelberg Germany
Department of Urology, West German Cancer Center, University Duisburg Essen, University Hospital Essen, Essen, Germany
German Cancer Consortium (DKTK), Heidelberg, Germany
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Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung · University of Duisburg-Essen
Affiliation as printed
Department of Urology West German Cancer Center University Duisburg Essen, University Hospital Essen Essen Germany
German Cancer Consortium (DKTK) Heidelberg Germany
Department of Urology, West German Cancer Center, University Duisburg Essen, University Hospital Essen, Essen, Germany
German Cancer Consortium (DKTK), Heidelberg, Germany
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Ulrich Krafft corresponding
Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung · University of Duisburg-Essen
Affiliation as printed
Department of Urology West German Cancer Center University Duisburg Essen, University Hospital Essen Essen Germany
German Cancer Consortium (DKTK) Heidelberg Germany
Department of Urology, West German Cancer Center, University Duisburg Essen, University Hospital Essen, Essen, Germany
German Cancer Consortium (DKTK), Heidelberg, Germany
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