Fluorescence-Guided Surgery in Colorectal Cancer: State-of-the-Art and Translational Perspectives

Area of Science:

• Surgical Oncology
• Medical Imaging
• Gastroenterology

Background:

• Near-infrared imaging with indocyanine green (ICG) is increasingly utilized in colorectal cancer (CRC) surgery.
• This review examines evidence in anastomotic perfusion, lymphatic mapping, tumor localization, and metastasis detection.

Purpose of the Study:

• To integrate current evidence on ICG-based fluorescence imaging in CRC surgery.
• To emphasize technical and translational factors for broader clinical implementation.

Main Methods:

• A structured narrative review of clinical and translational studies was performed.
• PubMed and citation tracking were used, focusing on ICG workflows and emerging tracers.

Main Results:

• ICG angiography refines transection selection but its effect on anastomotic leak is protocol-dependent.
• ICG aids lymphatic mapping and tumor localization but struggles to differentiate benign from metastatic nodes.
• For metastatic disease, ICG is useful for liver margins and residual disease detection; targeted probes show promise for peritoneal metastases.

Conclusions:

• Fluorescence imaging is valuable in selected CRC surgery settings.
• Broader adoption hinges on standardized protocols, real-time quantification, and multicenter validation of targeted tracers.