Green Fluorescence Imaging (ICG) for the Study of Lymphatic Drainage in Pancreatic Head Tumors

Porpose: Pancreatic cancer is a dismal prognosis tumor. Only about 5-15% of treated patients will live 5 years after diagnosis, mainly cause by the invasion of lymph nodes as well as distant metastasis. For this reason lymphadenectomy plays an important role. Green fluorescence imaging (ICG) can distinguish lymphatic tissue containing ICG letting us determining the drainage pathway in each patient, which allows us to perform tailor-made lymphadenectomy. Our aim is to standardize the technique of administration of ICG for the study of lymphatic drainage in pancreatic head tumors. Methods: Between December 2019 and December 2020, lymphatic drainage was analyzed in 6 patients with adenocarcinoma of the pancreatic head who underwent to duodenopancretectomy by open approach. In all cases, 1mL of ICG diluted to 10% was given, in 3 cases was infused peritumoral and in the other ones intratumoral (image 1) . The Spy-Phi camera from Novadaq Stryker System was used to visualize the ICG. Lymphatic migration of the ICG was verified after 12 minutes taking as a sample the first lymph node of drainage. Drainage routes, patient demographic data, tumor stage, pathological analysis and tumor measurement were studied. Results: The determination of the drainage and first nodal station was only satisfactory in intratumoral application (Table 1). The mean detection time was 15 minutes. Lymphatic drainage of 5 patients was the hepatic artery station 8 and 1 patient in interaortocava station with a positive result in that region. Conclusion: The application of ICG for the study of lymphatic drainage of pancreatic head tumors is feasible and standardized.Tabled 1EP182_Table 1:PatientAdministrationTumor locationDetection timePathwayNodePositive1PeritumoralHead5 min.Hepatic arteryNo2PeritumoralUncinate process15 min.Hepatic arteryNo3IntratumoralAmpuloma10 minHepatic arteryYesNegative4PeritumoralUncinate process15 minHepatic arteryNo5IntratumoralUncinate process15 minInter aorto-cavaYesPositive6IntratumoralHead15 minHepatic arteryYesPositive Open table in a new tab