Near-infrared fluorescence clip guided robot-assisted minimally invasive esophagectomy for esophagogastric junction cancer: a case report

Although treatment strategy differs between countries, surgery remain the mainstay of treatment for localized esophagogastric junction cancer. Tumor proximal margin is one of the critical factors to achieve curative resection during esophagogastric junction cancer surgery. Thus, an accurate preoperative marking of the tumor is essential, however, accuracy of conventional methods was highly dependent upon endoscopists skills. Here, we present a case of a patient with locally advanced Siewert type II esophagogastric junction cancer treated by robot-assisted minimally invasive esophagectomy utilizing near-infrared fluorescence clip as a novel marking method.

A male patient in his 70 s was diagnosed as having cT3N1M1 esophagogastric junction cancer and was treated by immunochemotherapy followed by surgery. Near-infrared fluorescence marking clips were placed 2 cm above the tumor proximal end under endoscopy prior to surgery. Location of the clips were confirmed by fluorescence imaging during robotic surgery, and the esophagus was dissected by a surgical stapler without intraoperative endoscopy. Histopathologically, the tumor was diagnosed as ypT2N0M0, with negative margins.

Near-infrared fluorescence clip may enable easy, safe, and an accurate preoperative marking, and may be considered during endoscopic surgeries.