rpmjResearch'n Practical Medicine JournalResearch and Practical Medicine Journal2410-1893"QUASAR", LLC10.17709/2410-1893-2025-12-4-4TIAPIQrpmj-1161Research ArticleОригинальные статьиOriginal ArticlesОпыт применения интраоперационной лимфографии с индоцианином зеленым при планировании резекции печени у больных билиарным ракомIntraoperative lymphography with indocyanine green experience in liver resection planning in patients with biliary cancerhttps://orcid.org/0009-0002-8236-2808КоршакА. В.KorshakA. V.

 

Коршак Алина Владимировна – врач-онколог отделения абдоминальной онкологии № 2 (опухолей гепатопанкреатобилиарной зоны) ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Министерства здравоохранения Российской Федерации, г. Москва, Российская Федерация

ORCID: https://orcid.org/0009-0002-8236-2808, Scopus Author ID: 58681896200

 

Alina V. Korshak – oncologist of the Department of Abdominal Oncology No. 2 (tumors of the hepatopancreatobiliary zone), N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation

ORCID: https://orcid.org/0009-0002-8236-2808

Scopus Author ID: 58681896200

Alina-korshak@mail.ruhttps://orcid.org/0000-0001-7375-3378ПодлужныйД. В.PodluzhnyiD. V.

 

Подлужный Данил Викторович – к.м.н., ведущий научный сотрудник отделения абдоминальной онкологии № 2 (опухолей гепатопанкреатобилиарной зоны) ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Министерства здравоохранения Российской Федерации, г. Москва, Российская Федерация

ORCID: https://orcid.org/0000-0001-7375-3378

eLibrary SPIN: 3537-3436, AuthorID: 583879

Scopus Author ID: 56801896900

 

Danil V. Podluzhny – Cand. Sci. (Medicine), Leading Researcher of the Department of abdominal oncology No. 2 (tumors of the hepatopancreatobiliary zone), N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0001-7375-3378

eLibrary SPIN: 3537-3436, AuthorID: 583879

Scopus Author ID: 56801896900

danil-p@mail.ruhttps://orcid.org/0000-0002-2811-0549КотельниковА. Г.KotelnikovA. G.

 

Котельников Алексей Геннадьевич – д.м.н., профессор, ведущий научный сотрудник отделения абдоминальной онкологии № 2 (опухолей гепатопанкреатобилиарной зоны) ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Министерства здравоохранения Российской Федерации, г. Москва, Российская Федерация

ORCID: https://orcid.org/0000-0002-2811-0549

eLibrary SPIN: 8710-4003, AuthorID: 105352

Scopus Author ID: 7005528750

 

Alexey G. Kotelnikov – Dr. Sci. (Medicine), Professor, Leading Researcher of the Department of abdominal oncology No. 2 (tumors of the hepatopancreatobiliary zone), N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0002-2811-0549

eLibrary SPIN: 8710-4003, AuthorID: 105352

Scopus Author ID: 7005528750

kotelnikovag@mail.ruhttps://orcid.org/0009-0004-1780-8388ГазарянЭ. О.GazaryanE. O.

 

Газарян Эдуард Оганович – врач-онколог поликлинического отделения ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Министерства здравоохранения Российской Федерации, г. Москва, Российская Федерация

ORCID: https://orcid.org/0009-0004-1780-8388

 

Eduard O. Gazaryan – MD, oncologist, outpatient care, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation

ORCID: https://orcid.org/0009-0004-1780-8388

ed.87@bk.ruhttps://orcid.org/0000-0001-9126-3153УмирзоковА. Ш.UmirzokovA. Sh.

 

Умирзоков Анваржон Шавкатович – студент, аспирант отделения абдоминальной онкологии № 2 (опухолей гепатопанкреатобилиарной зоны) ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Министерства здравоохранения Российской Федерации, г. Москва, Российская Федерация

ORCID: https://orcid.org/0000-0001-9126-3153

 

Anvarjon Sh. Umirzokov – postgraduate student of the Department of Abdominal Oncology No. 2 (tumors of the hepatopancreatobiliary zone, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0001-9126-3153

anvarjononcolgy@gmail.comhttps://orcid.org/0000-0003-2142-661XСавченкоИ. В.SavchenkoI. V.

 

Савченко Илья Вячеславович – врач-онколог отделения противоопухолевой лекарственной терапии № 3 отдела лекарственного лечения ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Министерства здравоохранения Российской Федерации, г. Москва, Российская Федерация

ORCID: https://orcid.org/0000-0003-2142-661X

 

Ilya V. Savchenko – oncologist of Department of Antitumor Drug Therapy No. 3 (Department of Drug Treatment), N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0003-2142-661X

sv2505.is2006@gmail.comhttps://orcid.org/0000-0003-2074-0877БаталоваМ. В.BatalovaM. V.

 

Баталова Мария Васильевна – к.м.н., врач-рентгенолог отделения лучевой диагностики ГБУЗ «Городская клиническая больница им. В. М. Буянова» Департамента здравоохранения г. Москвы, г. Москва, Российская Федерация

ORCID: https://orcid.org/0000-0003-2074-0877

 

Maria V. Batalova – Cand. Sci. (Medicine), radiologist of the Diagnostic Radiology Department, Buyanov City Clinical Hospital, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0003-2074-0877

dr.mariab@gmail.comhttps://orcid.org/0000-0001-5348-5011ПоляковА. Н.PolyakovA. N.

 

Поляков Александр Николаевич – к.м.н., старший научный сотрудник отделения абдоминальной онкологии № 2 (опухолей гепатопанкреатобилиарной зоны) ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Министерства здравоохранения Российской Федерации, г. Москва, Российская Федерация

ORCID: https://orcid.org/0000-0001-5348-5011

eLibrary SPIN: 9924-0256, AuthorID: 764535

Scopus Author ID: 57190413973

WoS ResearcherID: ABB-8912-2021

 

Alexander N. Polyakov – Cand. Sci. (Medicine), Senior Researcher, Department of Abdominal Oncology No. 2 (tumors of the hepatopancreatobiliary zone, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0001-5348-5011

eLibrary SPIN: 9924-0256, AuthorID: 764535

Scopus Author ID: 57190413973

WoS ResearcherID: ABB-8912-2021

Dr.alexp@gmail.comНациональный медицинский исследовательский центр онкологии им. Н. Н. Блохина Министерства здравоохранения Российской Федерации <p> г. Москва, Российская ФедерацияN.N. Blokhin National Medical Research Center of Oncology <p> Moscow, Russian FederationГородская клиническая больница им. В. М. Буянова Департамента здравоохранения г. Москвы <p> г. Москва, Российская ФедерацияV.M. Buyanov City Clinical Hospital <p> Moscow, Russian Federation2025111220251244455Copyright &#x00A9; Коршак А.В., Подлужный Д.В., Котельников А.Г., Газарян Э.О., Умирзоков А.Ш., Савченко И.В., Баталова М.В., Поляков А.Н., 20252025Коршак А.В., Подлужный Д.В., Котельников А.Г., Газарян Э.О., Умирзоков А.Ш., Савченко И.В., Баталова М.В., Поляков А.Н.Korshak A.V., Podluzhnyi D.V., Kotelnikov A.G., Gazaryan E.O., Umirzokov A.S., Savchenko I.V., Batalova M.V., Polyakov A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpmj.ru/rpmj/article/view/1161Цель исследования

Цель исследования. Оценить целесообразность интраоперационной лимфографии с индоцианином зеленым (ИЦЗ) при холангиокарциноме и раке желчного пузыря в случае планирования резекции печени и лимфодиссекции.

Пациенты и методы

Пациенты и методы. В исследование включены 26 больных билиарным раком, которым за период с 2023 по 2025 г. интраоперационно при планировании лимфодиссекции и резекции печени была применена флуоресцентная лимфография с индоцианином зеленым (ИЦЗ-лимфография). Изучался лимфоотток от печени и желчных протоков на 1-, 3-, 5-, 10-, 15-, 30‑й минутах ± 45‑й минутах от введения ИЦЗ с определением первых трех прокрашенных лимфатических узлов (ЛУ) – сторожевых лимфатических узлов (СЛУ) с последующей лимфодиссекцией регионарных ЛУ, а также всех прокрашенных ЛУ вне зон регионарного метастазирования. При технической возможности выполняли запланированный объем операции на печени и желчевыводящих путях.

Результаты

Результаты. У двух пациентов (7,7 %) не было выявлено ни одного СЛУ: в этой группе метастазов в ЛУ не было. В остальных случаях (92,3 %, n = 24) отмечено накопление ИЦЗ в одном или нескольких ЛУ. Поражение ЛУ по данным морфологического исследования отмечено у 12 пациентов. В этой группе больных при использовании в качестве СЛУ первых двух прокрашенных ЛУ чувствительность метода составила 91,7 % (n = 11/12). Изучение третьего СЛУ не повлияло на чувствительность метода, но позволило выявить пораженные ЛУ вне зон регионарного метастазирования в двух случаях.

Заключение

Заключение. ИЦЗ-лимфография – перспективный метод для определения СЛУ и путей лимфооттока при билиарном раке. Целесообразно оценить влияние лимфодиссекции выполненной с учетом флуоресцентной лимфографии на отдаленные результаты у больных с резектабельным билиарным раком.

Purpose of the study was to evaluate the feasibility of intraoperative lymphography with indocyanine green in cholangiocarcinoma and gallbladder cancer.

Patients and methods

Patients and methods. The study included 26 patients with biliary cancer, who underwent intraoperative fluorescent lymphography with indocyanine green (ICG lymphography) during the period from April 2023 to January 2025 while planning lymph node (LN) dissection and liver resection. The lymph drainage from the liver and bile ducts was studied at 1, 3, 5, 10, 15, 30 ± 45 minutes from the ICG introduction with the determination of the first three stained LNs – sentinel lymph nodes (SLNs) – followed by subsequent LN dissection with the removal of regional LNs, as well as all stained LNs outside the areas of regional metastases. When technically possible, the planned volume of liver surgery and biliary tract resection was performed.

Results

Results. In two cases (7.7 %) no SLN was detected, in this group there were no metastases in the LNs. In the remaining cases (92.3 %, n = 24), accumulation of ICG in one or more LNs was noted. LN invasion was noted in 12 patients. In this group, when using the first two stained LNs as SLNs, the sensitivity was 91.7 % (n = 11/12). Studying SLN 3 did not affect the sensitivity, but allowed identifying affected LNs outside the areas of regional metastases in two cases (7,7 %).

Conclusion

Conclusion. ICG lymphography is a promising method for determination of the SLNs and lymphatic drainage pathways in biliary cancer. It is advisable to evaluate the effect of LN dissection performed using fluorescence lymphography on long-term outcomes in patients with resectable biliary cancer.

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The authors declare that there are no conflicts of interest present.