Supplementary Information
gastric cancer, gastric adenocarcinoma
EVENT, SENTINEL LYMPH NODE, GASTRIC ADENOCARCINOMA, BLIND, GASTRIC CANCER
The online version contains supplementary material available at 10.1245/s10434-023-13848-y.Open access funding provided by Università degli Studi di Milano within the CRUI-CARE Agreement.Despite advances in systemic therapies and neoadjuvant strategies, the mainstay curative intent treatment for resectable gastric adenocarcinoma remains gastrectomy with lymphadenectomy.Indocyanine green (ICG) is a fluorescent dye that can be visualized in the near-infrared (NIR) spectrum. Thanks to its excellent safety profile and fluorescent properties, ICG has several uses in the medical field. ICG has been successfully utilized for sentinel lymph node (SLN) visualization in different areas of surgical oncology, including urology, gynecology, and breast surgery.The utility of NIR-visualization for D2 lymphadenectomy in gastric cancer is currently under investigation. A recent meta-analysis has shown a mean increase of 7 (95% confidence interval [CI] 1.37–12.67) lymph nodes retrieved during NIR-guided D2 lymphadenectomy compared with standard visualization.In this study, we conducted a single-arm, Simon’s two-stage, phase II trial designed to prospectively assess the clinical benefit of NIR visualization in D2 lymphadenectomy during laparoscopic distal gastrectomy for gastric adenocarcinoma. To avoid performance bias, we planned to use NIR visualization only at the end of standard “blind” D2 lymphadenectomy to evaluate the pure impact of the technique. We considered retrieval of nonnodal tissue (nodal noncompliance) as a potentially harmful event, and in each patient, NIR was considered useful only if the number of additional retrieved nodes was higher than the number of nonnodal tissues.