BackgroundThe extent of pelvic lymphadenectomy (PLND) as part of radical cystectomy (RC) for bladder cancer (BC) remains unclear. Sentinel‐based and lymphangiographic approaches could lead to reduced morbidity without sacrificing oncologic safety.ObjectiveTo evaluate the feasibility and diagnostic value of fluorescence‐guided template sentinel region dissection (FTD) using a handheld near‐infrared fluorescence (NIRF) camera in open radical cystectomy.Design, Setting, and ParticipantsAfter peritumoral cystoscopic injection of indocyanine green (ICG) 21 patients underwent open RC with FTD due to BC between June 2019 and June 2021. Intraoperatively, the FIS‐00 Hamamatsu Photonics® NIRF camera was used to identify and resect fluorescent template sentinel regions (FTRs) followed by extended pelvic lymphadenectomy (ePLND) as oncological back‐up.Outcome Measurement and Statistical AnalysisDescriptive analysis of positive and negative results per template region.Results and LimitationsFTRs were identified in all 21 cases. Median time (range) from ICG injection to fluorescence detection was 75 (55–125) minutes. On average (SD), 33.4 (9.6) lymph nodes were dissected per patient. Considering template regions as the basis of analysis, 67 (38.3%) of 175 resected regions were NIRF‐positive, with 13 (7.4%) regions harboring lymph node metastases. We found no metastatic lymph nodes in NIRF‐negative template regions. Outside the standard template, two NIRF‐positive benign nodes were identified.ConclusionThe concept of NIRF‐guided FTD proved for this group all lymph node metastases to be found in NIRF‐positive template regions. Pending validation in a larger collective, resection of approximately 40% of standard regions may be sufficient and may result in less morbidity.

中文翻译：

---

使用创新手持设备进行膀胱癌开放根治性膀胱切除术的近红外荧光淋巴结模板区域切除加备用淋巴结切除术：单中心经验

背景作为膀胱癌（BC）根治性膀胱切除术（RC）的一部分，盆腔淋巴结切除术（PLND）的范围仍不清楚。基于前哨和淋巴管造影的方法可以在不牺牲肿瘤学安全性的情况下降低发病率。目的评估使用手持式近红外荧光（NIRF）相机进行荧光引导模板前哨区解剖（FTD）在开放根治性膀胱切除术中的可行性和诊断价值。设计、设置和参与者 2019 年 6 月至 2021 年 6 月期间，21 名患者在瘤周膀胱镜注射吲哚菁绿 (ICG) 后因 BC 接受 FTD 开放式 RC。术中使用 FIS-00 Hamamatsu Photonics® NIRF 相机识别和切除荧光模板前哨区域 (FTR)，然后进行扩大盆腔淋巴结切除术 (ePLND) 作为肿瘤学备份。结果测量和统计分析每个模板区域的阳性和阴性结果的描述性分析。结果和局限性 在所有 21 例中均确定了 FTR。从 ICG 注射到荧光检测的中位时间（范围）为 75 (55–125) 分钟。平均 (SD)，每位患者解剖 33.4 (9.6) 个淋巴结。将模板区域作为分析基础，175 个切除区域中的 67 个（38.3%）为 NIRF 阳性，其中 13 个（7.4%）区域存在淋巴结转移。我们在 NIRF 阴性模板区域没有发现转移淋巴结。在标准模板之外，识别出两个 NIRF 阳性良性淋巴结。结论 NIRF 引导 FTD 的概念证明该组所有淋巴结转移均发现于 NIRF 阳性模板区域。在更大的集体中进行验证之前，切除大约 40% 的标准区域可能就足够了，并且可能会降低发病率。