Identification of lymphatic pathway involved in the spreading of prostate cancer by fluorescence navigation approach with intraoperatively injected indocyanine green
DOI:
https://doi.org/10.5489/cuaj.659Abstract
Objective: The objective of this study was to identify lymphatic
vessels draining from the prostate by using a fluorescence navigation
(FN) system.
Methods: Fourteen subjects were candidates for radical retropubic
prostatectomy (RRP) and pelvic lymph node dissection (PLND).
After an indocyanine green solution was injected into the prostate
during RRP, lymphatic vessels draining from the prostate were analyzed
using a FN system. After PLND based on lymphatic mapping
by the FN system (in vivo probing) was performed in the external
iliac, obturator and internal iliac regions; the fluorescence of the
removed lymph nodes (LNs) was analyzed on the bench (ex vivo
probing).
Results: Under in vivo and ex vivo probing, the fluorescence intensity
of internal iliac nodes was greater than that of external iliac
or obturator nodes.
Conclusion: The current study suggests that using a FN system
after injecting indocyanine green is a safe and rational approach
for detecting the lymphatic channel draining from the prostate.
The major lymphatic pathway involved in the spreading of prostate
cancer appears to relate to internal iliac LNs, which would
mean that the standard PLND covering external iliac and obturator
regions would not keep the cancer from spreading.
Objectif : L’objectif de l’étude était de repérer les vaisseaux lymphatiques
quittant la prostate à l’aide d’un système d’imagerie par
fluorescence (IF).
Méthodologie : Quatorze sujets devaient subir une prostatectomie
radicale rétropubienne (PRR) et une lymphadénectomie pelvienne.
Après injection d’une solution de vert d’indocyanine dans
la prostate pendant la PRR, les vaisseaux lymphatiques drainant la
prostate ont été analysés par IF. Une lymphadénectomie pelvienne
fondée sur la cartographie lymphatique par IF (exploration in vivo)
a ensuite été réalisée dans les régions de la fosse iliaque externe,
de l’obturateur et de la fosse iliaque interne; la fluorescence des
ganglions lymphatiques retirés a été analysée sans délai (exploration
ex vivo).
Résultats : Lors de l’exploration in vivo et ex vivo, l’intensité de
la fluorescence des ganglions iliaques internes était plus forte que
celle des ganglions iliaques externes ou des ganglions obturateurs.
Conclusion : Cette étude porte à croire que l’IF après injection
de vert d’indocyanine est une méthode sûre et rationnelle pour
repérer les vaisseaux lymphatiques drainant la prostate. La principale
voie lymphatique de propagation du cancer de la prostate
semble être reliée aux ganglions lymphatiques iliaques internes, ce
qui signifie que la lymphadénectomie pelvienne standard retirant
les ganglions iliaques externes et obturateurs n’empêcherait pas
le cancer de se propager.
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