Live surgeryApril 29, 20232:22:338 speakersAvailable in: EN / IT
Hot Topics in Upper GI Surgery: ICG in Esophagectomy, Gastrectomy and Lymphadenectomy
Four hot topics in upper GI surgery: use of ICG in Ivor Lewis esophagectomy, subtotal vs total gastrectomy, D2 vs D2+ lymphadenectomy, and organ-sparing surgery in early gastric cancer.
Free content for members
Sign in to watch this episode
Full surgical procedures, chapter-marked discussions, and bilingual transcripts — all free for registered members.
Clinical historyBuone condizioni generali, lesione piccola distale identificata endoscopicamente
NotesCaso operato in diretta durante precedente sessione Permanent School: marcatura endoscopica ICG, wedge resection laparoscopica con sentinel node navigation, esame estemporaneo del pezzo, dimissione in 3a giornata. Vengono presentati anche altri 4 casi simili di chirurgia di risparmio d'organo gastrico.
Overview
Episode of the Permanent School on ICG Surgery dedicated to 'Hot Topics' in upper gastrointestinal surgery, moderated by Domenico D'Ugo with organizational direction by Gian Luca Baiocchi and the support of Stryker. The session is structured in four blocks, each with a speaker and a 'shooter' who critically comments on the presentation.
In the first block, Ugo Elmore (San Raffaele, Rosati group) presents the Milan school's experience on the use of indocyanine green in minimally invasive Ivor Lewis esophagectomy: assessment of gastric conduit perfusion (Angio-Green Esophagus Study, SPY quantification), identification of the thoracic duct via inguinal lymph node injection to prevent chylothorax, and lymph node mapping (still preliminary). Uberto Fumagalli serves as shooter, highlighting biases and the maturity of the evidence. Next, Fabio Cianchi (Florence) addresses the choice between total and subtotal gastrectomy, focusing on resection margins, Lauren histotype, and Japanese vs Western guidelines; Federico Marchesi comments from a laparoscopic perspective.
In the third block, Simone Giacopuzzi (Verona) discusses D2 vs D2+, historically reviewing Sasako's JCOG 9501, the role of lymph node stations 13, 14V, 12P, 8P and 16, the era of neoadjuvant therapy and molecular biology (MSI), with commentary by Stefano Rausei. Gian Luca Baiocchi (Cremona) closes by presenting Sentinel Node Navigation Surgery in light of the recent results of the Korean SENORITA trial (JCO 2022), with his own initial series of organ-sparing surgery in early gastric cancer, emphasizing the need for strict selection criteria, dedicated informed consent, and tight follow-up protocols. D'Ugo concludes by proposing the development of 'gastric oncoplasty' guidelines.
Topics
Use of ICG for gastric conduit perfusion in esophagectomy
Fluorescence identification of the thoracic duct for chylothorax prevention
ICG lymph node mapping in esophagectomy
Total vs subtotal gastrectomy: indications and resection margins
Lauren classification and impact on surgical margins
Proximal gastrectomy and reconstructive techniques
D2 vs D2+ lymphadenectomy in gastric cancer
Role of molecular biology (MSI) in surgical decision-making
Laparoscopic lymphadenectomy and lymph node compliance
Sentinel Node Navigation Surgery and the SENORITA trial
