Prognostic impact of fluorescent lymphography on gastric cancer

Background: Fluorescent lymphography-guided lymphadenectomy for gastric cancer is gaining popularity. However, its impact on prognosis is not known. This study aimed to assess the prognostic impact of fluorescent lymphography-guided lymphadenectomy in gastric cancer patients. Materials and Methods: This study retrospectively analyzed 5,678 gastric cancer patients who underwent gastrectomy from 2013 to 2017. The survival was compared between the fluorescent lymphography-guided lymphadenectomy (FL group) and the conventional lymphadenectomy (non-FL group) using 1:1 propensity score matching after exclusion. Patients in the FL group underwent gastrectomy with systematic lymphadenectomy after endoscopic peritumoral injection of indocyanine green the day before surgery. Results: After propensity score matching, the FL and non-FL groups each had 1064 patients with similar demographic and clinicopathological characteristics. All matched variables had a standardized mean difference under 0.1. The FL group showed a significantly higher number of retrieved lymph nodes (56.2±20.1) than the non-FL group (46.2±18.2, P<0.001). The FL group also had more stage III patients (P=0.044) than the non-FL group. The FL group demonstrated higher overall survival (P=0.038) and relapse-free survival (P=0.036) in stage III compared to the non-FL group. However, no significant differences in overall and relapse-free survival were observed between the two groups for stages I (P=0.420 and P=0.120, respectively) and II (P=0.200 and P=0.280, respectively). Conclusion: Fluorescent lymphography-guided lymphadenectomy demonstrated a higher survival in stage III gastric cancer patients by the more accurate staging resulting from larger lymph node retrieval. Thus, given its potential to improve prognostication by enhancing staging accuracy, it is recommended as an option to consider the use of fluorescent lymphography-guided lymphadenectomy in clinical practice.