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Fluorescence lymph node mapping using ICG improves lateral lymph node dissection for mid-low rectal cancer: a
1Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Techniques in Coloproctology
|July 13, 2025
Summary
Indocyanine green (ICG)-assisted lateral lymph node dissection (LLND) improved lymph node harvest and reduced hospital stays for rectal cancer patients. This technique enhances surgical outcomes without increasing complications.
Area of Science:
- Surgical Oncology
- Medical Imaging
- Rectal Cancer Treatment
Background:
- Lateral lymph node metastasis (LLNM) poses diagnostic and therapeutic challenges in rectal cancer.
- Current treatment strategies require optimization for patients with LLNM.
Purpose of the Study:
- To evaluate the effectiveness of indocyanine green (ICG)-assisted lymph node mapping with near-infrared imaging (NIRI) in enhancing lateral lymph node dissection (LLND).
- To assess the impact of ICG-LLND on lymph node categorization and surgical outcomes in mid-low rectal cancer patients.
Main Methods:
- Submucosal ICG injection at the distal rectal cancer margin.
- Laparoscopic NIRI system used for ICG-LLND to visualize lymphatic pathways and lateral lymph nodes (LLNs).
- Pathological evaluation of harvested lymph nodes in both ICG-LLND and control groups.
Main Results:
- ICG-LLND group showed significantly shorter postoperative hospital stays.
- Higher total and lateral lymph node harvest in the ICG-LLND group, including obturator and internal iliac regions.
- Increased detection of positive lymph nodes in obturator and internal iliac regions in the ICG-LLND group.
- No significant difference in blood loss or operating time; fewer anastomotic leakage cases observed.
Conclusions:
- ICG-LLND significantly improves lateral lymph node harvest, especially in the obturator region.
- This technique leads to shorter postoperative hospital stays without increasing complications.
- ICG-LLND shows potential to enhance surgical outcomes for patients undergoing lymph node dissection for rectal cancer.
