Esofagectomía con linfadenectomía guiada por fluorescencia con verde de indocianina en cáncer de esófago. Experiencia inicial en la Argentina / Esophagectomy with lymphadenectomy guided by fluorescence imaging with indocyanine green in esophageal cancer. Initial experience in Argentina

RESUMEN Antecedentes: en la última década ha comenzado a investigarse el uso de la captación de fluorescencia mediante luz infrarroja para la visualización de ganglios linfáticos en tumores de estómago y esófago. Objetivo: evaluar la factibilidad de la evaluación del drenaje linfático de cáncer de esófago mediante el uso de fluorescencia y verde de indocianina (ICG). Material y métodos: se realizó un estudio prospectivo que incluyó pacientes con tumores de la unión gastroesofágica resecables (estadios I, II y III). Antes de comenzar la cirugía se inyectaron por endoscopia 4 mL de ICG doblemente diluida en agua estéril (1,25 mg/mL = 5 mg) en la submucosa del esófago en los cuatro cuadrantes (1 mL por cuadrante) alrededor del tumor. Resultados: se incluyeron en total 6 pacientes. En todos ellos se logró identificar el drenaje linfático del tumor hacia la primera estación ganglionar: en 6/6 (100%), el drenaje linfático con fluorescencia se detectó en las estaciones ganglionares N°s 3 y 7 (curvatura menor y arteria gástrica izquierda). En ningún paciente se identificó fluorescencia en ganglios mediastinales. Conclusión: la visualización del drenaje linfático de tumores de la unión gastroesofágica mediante el uso de fluorescencia con ICG es factible.

ABSTRACT Background: Over the past decade, fluorescence imaging with infrared light has been used to visualize lymph nodes in tumors of the stomach and esophagus. Objective: The aim of our study was to evaluate the feasibility of evaluating lymphatic drainage in esophageal cancer using fluorescence and indocyanine green (ICG). Material and methods: We conducted a prospective study of patients with resectable tumors of the gastroesophageal junction (stage I, II and III). Before surgery, 4 mL of ICG double diluted in sterile water (1.25 mg/mL = 5 mg) were injected via endoscopy into the esophageal submucosa in the four quadrants (1 mL per quadrant) around the tumor. Results: A total of 6 patients were included. Lymphatic drainage from the tumor to the first lymph node station was identified in all patients: in 6/6 (100%), fluorescent lymphatic drainage was detected in nodal stations number 3 and 7 (lesser curvature and left gastric artery) Fluorescence was not identified in the mediastinal lymph nodes in any patient. Conclusion: Visualization of lymphatic drainage of gastroesophageal junction tumors to the lesser curvature nodes using fluorescence imaging is feasible.

Near-infrared intraoperative imaging for minimally invasive pulmonary metastasectomy for sarcomas.

BACKGROUND: Complete pulmonary metastasectomy for sarcoma metastases provides patients an opportunity for long-term survival and possible cure. Intraoperative localization of preoperatively identified metastases and identification of occult lesions can be challenging. In this trial, we evaluated the efficacy of near-infrared (NIR) intraoperative imaging using second window indocyanine green during metastasectomy to identify known metastases and to detect occult nodules. METHODS: Thirty patients with pulmonary nodules suspicious for sarcoma metastases were enrolled in an open-label, feasibility study (NCT02280954). All patients received intravenous indocyanine green (5 mg/kg) 24 hours before metastasectomy. Patients 1 through 10 (cohort 1) underwent metastasectomy via thoracotomy to assess fluorescence patterns of nodules detected by traditional methods (preoperative imaging and intraoperative visualization/bimanual palpation). After confirming reliability within cohort 1, patients 11 through 30 (cohort 2) underwent video-assisted thoracic surgery metastasectomy with NIR imaging. RESULTS: In cohort 1, 14 out of 16 preoperatively identified pulmonary metastases (87.5%) displayed tumor fluorescence. Nonfluorescent metastases were deeper than fluorescent metastases (2.1 cm vs 1.3 cm; P = .03). Five out of 5 metastases identified during thoracotomy displayed fluorescence. NIR imaging identified 3 additional occult lesions in this cohort. In cohort 2, 33 out of 37 known pulmonary metastases (89.1%) displayed fluorescence. Nonfluorescent tumors were deeper than 2.0 cm (P = .007). NIR imaging identified 24 additional occult lesions. Of 24 occult lesions, 21 (87.5%) were confirmed metastases and the remaining 3 nodules were lymphoid aggregates. CONCLUSIONS: NIR intraoperative imaging with indocyanine green (5 mg/kg and 24 hours before surgery) localizes known sarcoma pulmonary metastases and identifies otherwise occult lesions. This approach may be a useful intraoperative adjunct to improve metastasectomy.

Adaptación del Inventario de Duelo Complicado en población colombiana / Adaptation of the Complicated Grief Inventory to the Colombian Population / Adaptação do Inventário de Luto Complicado na População Colombiana

Resumen Se realizó la adaptación del Inventario de Duelo Complicado (IDC) en población colombiana. Cinco jurados evaluaron el contenido y ajuste cultural del cuestionario y luego éste fue aplicado a una muestra de 120 adultos que experimentaron el fallecimiento de un familiar. Los análisis psicométricos indicaron una consistencia interna similar a la de la prueba original y superior a la de la adaptación española, buena estabilidad temporal, asociaciones positivas con pruebas de depresión y ansiedad usadas para evaluar la validez convergente y tres factores significativos. Se concluye que la versión adaptada del IDC tiene propiedades psicométricas adecuadas por lo que puede ser usada en población colombiana, pero se recomienda realizar una validación con una muestra más grande y usar herramientas como una entrevista clínica para establecer el alcance diagnóstico del inventario.

Abstract The Inventory of Complicated Grief (ICG) was adapted to Colombian people. Five juries evaluated the language and cultural adjustment of the Spanish version and then, the questionnaire was applied to 120 adults who had lost a family member. Psychometrical analysis showed an internal consistency similar to that one found in the original ICG, but higher than the one found in the Spain application. Convergent validity showed positive correlations between ICG and depression and anxiety tests, and three significant factors were identified. In brief, this adapted spanish version of the ICG has good psychometric properties and it can be used with Colombian people, but a validation study with a larger sample and using tools such as a clinical interview to determine the diagnostic power of this inventory is recommended.

Resumo Realizou-se a adaptação do Inventário de Luto Complicado (IDC, em espanhol) na população colombiana. Cinco jurados avaliaram o conteúdo e o ajuste cultural do questionário e, em seguida, este foi aplicado a uma amostra de 120 adultos que experimentaram o falecimento de um familiar. As análises psicométricas indicaram uma consistência interna semelhante à do teste original e superior à da adaptação espanhola, boa estabilidade temporal, associações positivas com testes de depressão e ansiedade usados para avaliar a validade convergente e três fatores significativos. Conclui-se que a versão adaptada do idc tem propriedades psicométricas adequadas, portanto pode ser usada na população colombiana, mas se recomenda realizar uma validação com uma amostra maior e usar ferramentas como uma entrevista clínica para estabelecer o alcance diagnóstico do inventário.