Indocyanine Green Fluorescence Imaging-Guided Laparoscopic Surgery Could Achieve Radical D3 Dissection in Patients With Advanced Right-Sided Colon Cancer

Park, Soo Yeun; Park, Jun Seok; Kim, Hye Jin; Woo, In Teak; Park, In Kyu; Choi, Gyu–Seog

doi:10.1097/dcr.0000000000001597

Cited by 41 publications

(57 citation statements)

References 26 publications

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“…As ICG fluorescence imaging has proven to be a useful tool for identifying lymphatic drainage in colorectal surgery[ 82 , 83 ], ICG-enhanced NIR fluorescence-guided imaging has been used to improve the accuracy and the completeness of LLND. In such cases, ICG fluorescence imaging is carried out the injection of ICG dye into the submucosal layer on the distal side of the tumor through the anus immediately before surgery.…”

Section: Lymph Node Mappingmentioning

confidence: 99%

Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art

Peltrini¹,

Podda²,

Castiglioni³

et al. 2021

WJG

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Indocyanine green (ICG) fluorescence imaging is widely used in abdominal surgery. The implementation of minimally invasive rectal surgery using new methods like robotics or a transanal approach required improvement of optical systems. In that setting, ICG fluorescence optimizes intraoperative vision of anatomical structures by improving blood and lymphatic flow. The purpose of this review was to summarize all potential applications of this upcoming technology in rectal cancer surgery. Each type of use has been separately addressed and the evidence was investigated. During rectal resection, ICG fluorescence angiography is mainly used to evaluate the perfusion of the colonic stump in order to reduce the risk of anastomotic leaks. In addition, ICG fluorescence imaging allows easy visualization of organs such as the ureter or urethra to protect them from injury. This intraoperative technology is a valuable tool for conducting lymph node dissection along the iliac lymphatic chain or to better identifying the rectal dissection planes when a transanal approach is performed. This is an overview of the applications of ICG fluorescence imaging in current surgical practice and a synthesis of the results obtained from the literature. Although further studies are need to investigate the real clinical benefits, these findings may enhance use of ICG fluorescence in current clinical practice and stimulate future research on new applications.

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Section: Lymph Node Mappingmentioning

confidence: 99%

Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art

Peltrini¹,

Podda²,

Castiglioni³

et al. 2021

WJG

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show abstract

“…In colon cancer surgery, FLNM helps the surgeon visualize the lymphatic pathway to perform a more accurate dissection of the lymph nodes, especially around the main surgical trunk. Interestingly, the FLNM technique can increase the total number of harvested lymph nodes [ 75 , 76 ]. When visualizing the lymph nodes and lymphatic drainage pathway directly, the surgeon can dissect lymph nodes much more radically.…”

Section: Novel Technology Of Lymph Node Mappingmentioning

confidence: 99%

Is Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation Really Necessary for All Patients With Right-Sided Colon Cancer?

Son

Lee

et al. 2021

Ann Coloproctol

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Colon cancer treatment is on the way to evolution over several decades. The minimally invasive surgery has improved postoperative short-term outcomes. Adjuvant chemotherapy has prolonged the survival of advanced colon cancer patients. Hohenberger proposed the noble concept of complete mesocolic excision (CME) which consists of 3 components: plane surgery, sufficient longitudinal bowel resection, and central vascular ligation (CVL). Mesocolic plane surgery shares the same surgical principle of total mesorectal excision, which is maintaining the intact mesothelial envelope. However, there remain debates about the extent of bowel resection and the level of CVL for maximizing lymph node dissection. There is no solid clinical evidence for the oncological necessity and benefit of extended radical dissection in right hemicolectomy. CME with CVL based on open surgery has been adopted in laparoscopic surgery. So, it is also necessary to look at how the CME could be transformed and successfully implanted in the laparoscopic era. Recent rapid advances in surgical technology and cancer biology are preparing for fundamental changes in cancer surgery. In this study, we reviewed the history, oncological necessity, and compatibility of CME for the right hemicolectomy in the laparoscopic era and outline the new perspectives on the evolution of cancer surgery.

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“…The patients' body mass index (BMI) can affect the success of FLNM because higher BMI means more visceral fat tissue and that can disturb the fluorescence signals of lymph nodes that are covered with thick mesenteric fat tissue [10]. FLNM protocols have been introduced from previous studies and summarized in Table 2 [7,8,10,[31][32][33][34][35][36][37][38][39][40][41].…”

Section: Fluorescence Lymph Node Navigationmentioning

confidence: 99%

“…In the comparison study between the ICG FLNM group and the conventional group, the total number of harvested lymph nodes was significantly higher with FLNM [ 31 ]. Being able to visualize the lymph nodes and lymphatic drainage pathway, the surgeon can dissect lymph nodes much more radically.…”

Section: Fluorescence Lymph Node Navigationmentioning

confidence: 99%

Multifunctional Indocyanine Green Applications for Fluorescence-Guided Laparoscopic Colorectal Surgery

et al. 2021

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Indocyanine green (ICG) could be applied for multiple functions such as fluorescent tumor localization, fluorescence lymph node mapping (FLNM), and intraoperative angiography in colorectal cancer surgery. With the near-infrared (NIR) systems, colonoscopic ICG tattooing can be used to define the early colorectal cancer that cannot be easily distinguished through the serosal surface. The lymphatic pathways can be visualized under the NIR system when ICG is injected through the submucosal or subserosal layer around the tumor. Intraoperative ICG angiography can be applied to find a favorable perfusion segment before the colon transection. Although all fluorescence functions are considered essential steps in image-guided surgery, it is difficult to perform multifunctional ICG applications in a single surgical procedure at once because complex protocols could interfere with each other. Therefore, we review the multifunctional ICG applications for fluorescent tumor localization, FLNM, and ICG angiography. We also discuss the optimal protocol for fluorescence-guided colorectal surgery.

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Indocyanine Green Fluorescence Imaging-Guided Laparoscopic Surgery Could Achieve Radical D3 Dissection in Patients With Advanced Right-Sided Colon Cancer

Cited by 41 publications

References 26 publications

Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art

Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art

Is Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation Really Necessary for All Patients With Right-Sided Colon Cancer?

Multifunctional Indocyanine Green Applications for Fluorescence-Guided Laparoscopic Colorectal Surgery

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