Application of indocyanine green-enhanced near-infrared fluorescence-guided imaging in laparoscopic lateral pelvic lymph node dissection for middle-low rectal cancer

Si-Cheng Zhou, Yan-Tao Tian, Xue-Wei Wang, Chuan-Duo Zhao, Shuai Ma, Jun Jiang, Er-Ni Li, Hai-Tao Zhou, Qian Liu, Jian-Wei Liang, Zhi-Xiang Zhou, Xi-Shan Wang, Si-Cheng Zhou, Yan-Tao Tian, Xue-Wei Wang, Chuan-Duo Zhao, Shuai Ma, Jun Jiang, Er-Ni Li, Hai-Tao Zhou, Qian Liu, Jian-Wei Liang, Zhi-Xiang Zhou, Xi-Shan Wang

Abstract

Background: As one effective treatment for lateral pelvic lymph node (LPLN) metastasis (LPNM), laparoscopic LPLN dissection (LPND) is limited due to the complicated anatomy of the pelvic sidewall and various complications after surgery. With regard to improving the accuracy and completeness of LPND as well as safety, we tried an innovative method using indocyanine green (ICG) visualized with a near-infrared (NIR) camera system to guide the detection of LPLNs in patients with middle-low rectal cancer.

Aim: To investigate whether ICG-enhanced NIR fluorescence-guided imaging is a better technique for LPND in patients with rectal cancer.

Methods: A total of 42 middle-low rectal cancer patients with clinical LPNM who underwent total mesorectal excision (TME) and LPND between October 2017 and March 2019 at our institution were assessed and divided into an ICG group and a non-ICG group. Clinical characteristics, operative outcomes, pathological outcomes, and postoperative complication information were compared and analysed between the two groups.

Results: Compared to the non-ICG group, the ICG group had significantly lower intraoperative blood loss (55.8 ± 37.5 mL vs 108.0 ± 52.7 mL, P = 0.003) and a significantly larger number of LPLNs harvested (11.5 ± 5.9 vs 7.1 ± 4.8, P = 0.017). The LPLNs of two patients in the non-IVG group were residual during LPND. In addition, no significant difference was found in terms of LPND, LPNM, operative time, conversion to laparotomy, preoperative complication, or hospital stay (P > 0.05).

Conclusion: ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could bring specific advantages regarding the accuracy and completeness of surgery as well as safety.

Keywords: Indocyanine green; Lateral pelvic lymph node; Lateral pelvic lymph node dissection; Rectal cancer.

Conflict of interest statement

Conflict-of-interest statement: There are no conflict of interests to declare.

Figures

Figure 1
Figure 1
Injection of indocyanine green dye to sites on the anal side of the tumour.
Figure 2
Figure 2
Determination of the direction of lateral lymph node drainage under the guidance of indocyanine green-enhanced near-infrared fluorescence-guided imaging. A: Normal imaging; B: Indocyanine green-enhanced near-infrared fluorescence-guided imaging.
Figure 3
Figure 3
Distinguishing between lymph nodes and non-lymphatic soft tissues. A: Normal imaging; B: Indocyanine green-enhanced near-infrared fluorescence-guided imaging.
Figure 4
Figure 4
Examination of blood vessels, nerves, and residual soft tissues. A: Normal imaging; B: Indocyanine green-enhanced near-infrared fluorescence-guided imaging.
Figure 5
Figure 5
Residual lymph nodes revealed by computed tomography imaging of two cases. A: Residual lymph nodes in the distal left internal iliac artery. B: Residual lymph nodes in the left obturator foramen region.

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Source: PubMed

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