OSATS scoring confirms ICG enhancement of performance in laparoscopic radical gastrectomy: a post-hoc analysis of a randomized controlled trial

Author:

Huang Ze-Ning1234,He Qi-Chen1234,Qiu Wen-Wu1234,Wu Ju12345,Zheng Chang-Yue12346,Lin Guo-Sheng1234,Li Ping1234,Wang Jia-Bin1234,Lin Jian-Xian1234,Lu Jun1234,Cao Long-Long1234,Lin Mi1234,Tu Ru-Hong1234,Zheng Chao-Hui1234,Chen Qi-Yue1234,Huang Chang-Ming1234,Xie Jian-Wei1234

Affiliation:

1. Department of Gastric Surgery

2. Department of General Surgery, Fujian Medical University Union Hospital

3. Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education

4. Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou

5. Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian

6. Department of Gastrointestinal Surgery, the Affiliated Hospital of Putian University, Putian, People’s Republic of China

Abstract

Background: Indocyanine green (ICG) fluorescence imaging is effective in increasing the number of lymph node dissections during laparoscopic radical gastrectomy; however, no studies have attempted to explain this phenomenon. Methods: This study utilized the data from a previous randomized controlled trial (FUGES-012 study) investigating ICG-guided laparoscopic radical gastrectomy performed between November 2018 and July 2019. The Objective Structured Assessments of Technical Skills (OSATS) scoring system was used to grade videos from the ICG and non-ICG groups. Patients with an OSATS score greater than 29 were classified as the high-OSATS population, while those with an OSATS score less than or equal to 29 were classified as the low-OSATS population. Results: A total of 258 patients were included in the modified intention-to-treat analysis: 129 in the ICG group and 129 in the non-ICG group. The OSATS score of the ICG group was higher than that of the non-ICG group (29.6±2.6 vs. 26.6±3.6; P<0.001). The ICG group underwent a significantly higher mean total number of lymph node dissections than the non-ICG group (50.5±15.9 vs. 42.0±10.3; adjusted P<0.001). The group assigned to ICG use, better OSATS (high-OSATS) scores were observed, which correlated with greater D2 lymph node retrieval (54.1±15.0 vs. 47.2±8.7; adjusted P=0.039). Finally, the ICG group had a lower rate of lymph node noncompliance than that of the non-ICG group (31.8 vs. 57.4%; P<0.001). Conclusions: By applying the ICG fluorescence navigation technique, better OSATS scores were observed, which correlated with greater lymph node retrieval and a lower lymph node noncompliance rate, as recommended for individualized laparoscopic radical gastrectomy.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

General Medicine,Surgery

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