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Timing of real-time indocyanine green fluorescence visualization for lymph node dissection during laparoscopic colon cancer surgery

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A Correction to this article was published on 16 February 2023

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Abstract

Purpose

Although numerous studies have highlighted the potential value of indocyanine green (ICG) imaging in lymph node dissection of cancer surgery, its efficacy and optimal method remain to be clarified. This study aimed to investigate how lymphatic flow observation via ICG fluorescence could contribute to colon cancer surgery.

Methods

From October 2018 to March 2021, a total of 56 patients with colon cancer who underwent laparoscopic complete mesocolic excision with intraoperative ICG imaging were analyzed. Lymphatic flow was examined at the following time points following ICG injection: within 5 min, 30–60 min, and over 60 min. We also evaluated the distribution of ICG fluorescence per each vascular pedicle.

Results

Lymphatic flow was observed within 5 min following ICG injection in 6 cases (10.7%), and at 30–60 min following ICG injection in 43 cases (76.8%). ICG-stained vascular pedicles were variable especially in hepatic flexural, transverse, and splenic flexural colon cancer. Lymph node metastases were observed in 14 cases. Although metastatic lymph nodes were present only in the area along the ICG-stained vascular pedicles in 12 of the 14 cases, two patients exhibited lymph node metastasis in areas along the ICG-unstained vascular pedicles. ICG fluorescence was observed outside the standard range of lymph node dissection in 9 cases (20.9%: 9/43). Although addition of the proposed resection areas was made in 8 of these 9 cases, there was no pathologically positive lymph node.

Conclusion

Real-time ICG fluorescence imaging of lymph nodes may improve the performance of laparoscopic colon cancer surgery, although its oncological benefit is not yet clear.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank medical staffs and residents of Kyoto University Hospital gastrointestinal surgery for their participation in this study.

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Authors and Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Hiromitsu Kinoshita, Kenji Kawada, Yoshiro Itatani, Ryosuke Okamura, Koya Hida & Kazutaka Obama

  2. Department of Surgery, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan

    Kenji Kawada

  3. Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan

    Nobu Oshima

  4. Department of Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan

    Tomoaki Okada

Authors
  1. Hiromitsu Kinoshita
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Contributions

K.K. and H.K. designed the study; contributed substantially to data acquisition, analysis, and interpretation; wrote the manuscript; and prepared the figures and tables. K.K., H.K., Y.I., R.O., N.O., T.O., and K.H. contributed to acquisition of the data. Y.I., R.O., N.O., T.O., K.H., and K.O. participated in drafting of the article. All authors revised the text critically for important intellectual content and gave approval of the final version of manuscript.

Corresponding author

Correspondence to Kenji Kawada.

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Ethics approval

The study protocol was approved by the Ethics Committee of Kyoto University (Y0001), and conformed to the Declaration of Helsinki.

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Written informed consent was obtained from all of the study participants.

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The authors declare no competing interests.

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Kinoshita, H., Kawada, K., Itatani, Y. et al. Timing of real-time indocyanine green fluorescence visualization for lymph node dissection during laparoscopic colon cancer surgery. Langenbecks Arch Surg 408, 38 (2023). https://doi.org/10.1007/s00423-023-02808-5

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