Fluorescence Guided Surgery in Gastric Cancer: What Do We Have and What Can We Do?

Fluorescence imaging has emerged as a valuable adjunct in gastric surgery, enhancing resection precision and oncologic outcomes. However, the use of indocyanine green (ICG) remains controversial due to uncertainties in efficacy and administration. A lack of standardized protocols persists. This review summarizes current applications of fluorescence in gastric cancer surgery, outlining existing challenges and future research needs.

A systematic PubMed search (2004-2024) was conducted using keywords such as "indocyanine green," "carbon particle," "blue dye," "gastric cancer," and "gastroesophageal junction cancer" to identify and review key uses of fluorescence agents in gastrointestinal malignancies.

Fluorescence-guided imaging aids intraoperative tumor localization, shortens operative time, and enhances lymph node (LN) yield, improving staging accuracy. Its role in sentinel lymph node (SLN) detection is still under debate due to false negatives. ICG fluorescence angiography (ICG-FA) may lower anastomotic leak rates, though strong supporting evidence is limited. No consensus exists regarding ICG dosage, timing, or delivery method.

Current evidence supports the safety and efficacy of fluorescence imaging in gastrointestinal surgery, with promising outcomes in precision and staging. However, uniform protocols for fluorescence use are urgently needed. Future studies should aim to standardize administration and optimize clinical implementation to fully realize its benefits.