Published online Aug 21, 2019. doi: 10.3748/wjg.v25.i31.4502
Peer-review started: May 27, 2019
First decision: June 16, 2019
Revised: July 8, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: August 21, 2019
Processing time: 87 Days and 2.5 Hours
Recently, ICG fluorescence-guided imaging has been applied to guide sentinel lymph node detection in various malignant tumours. As an 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 in terms of safety, we tried an innovative method using ICG visualized with a near-infrared camera (NIR) system to guide the detection of LPLNs in patients with middle-low rectal cancer.
The purpose of this study was to compare and analyse the clinical and pathological outcomes of LPND via an ICG-enhanced NIR fluorescence-guided imaging procedure vs a traditional procedure. The significance of this study is that it introduces a more effective and safe method for rectal cancer patients who undergo LPND.
The study aimed to evaluate the safety and availability of LPND via ICG-enhanced NIR fluorescence-guided imaging in patients with rectal cancer.
Middle-low rectal cancer patients who underwent total mesorectal excision (TME) and LPND were systemically reviewed between October 2017 and March 2019 at our institution. Clinical characteristics, operative outcomes, pathological outcomes, and postoperative complication information were collected and analysed using SPSS version 24.0 between the two groups.
The results showed that intraoperative blood loss was significantly lower in the ICG group than in the non-ICG group (P = 0.003). Compared to the non-ICG group, the ICG group had a significantly larger number of LPLNs harvested (11.5 ± 5.9 vs 7.1 ± 4.8, P = 0.017). 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).
ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could increase the number of LPLNs harvested and bring specific advantages regarding the accuracy and completeness of surgery as well as safety.
In this study, we emphasized that the location and concentration of ICG injection are critical for surgical outcome. Moreover, this is a retrospective study with a small sample size, and bias may exist. Further randomized prospective controlled trials are needed to confirm our results.