208. PREOPERATIVE NEAR-INFRARED FLUORESCENT CLIPPING IN ROBOT-ASSISTED THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

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Abstract Background In esophageal cancer surgery, ensuring a sufficient proximal margin without excessive resection is important for oncological safety and minimizing unnecessary resection while maintaining oncological safety. However, in minimally invasive and robot-assisted surgery, direct tumor palpation is not possible, and conventional methods like endoscopic tattooing or intraoperative endoscopy have certain limitations. This study aimed to evaluate the usefulness and safety of a new near-infrared fluorescent clip (Xemex FS marker) for tumor localization during robot-assisted esophagectomy. Methods This retrospective study included 37 patients with esophageal or esophagogastric junction cancer who underwent robot-assisted esophagectomy using Xemex FS marker between January 2023 and March 2024. Two fluorescent clips were placed 1 cm oral to the tumor on the right wall of the esophagus via endoscopy the day before surgery. During the operation, the Firefly system of the da Vinci surgical robot system was used to confirm clip location and determine the line of transection. Surgical outcomes, complications, and cost-saving effects were also evaluated. Results In all cases, the Firefly system detected the fluorescent clips, allowing precise tumor localization. No intraoperative complications related to the clip were observed. The median proximal margin was 52 mm, and no tumor exposure occurred. Postoperative complications included two cases of anastomotic leakage and two cases of pneumonia, all resolved conservatively. Eliminating intraoperative endoscopy reduced surgical time and personnel, saving 52,000 yen per case. Conclusion Xemex FS marker is an effective and safe method for tumor localization in robot-assisted esophageal cancer surgery. This technique improves surgical precision, reduces invasiveness, and has potential cost-saving benefits. Further studies are needed to evaluate its impact on long-term outcomes.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.