Indocyanine green fluorescence imaging in gastric cancer: Clinical efficacy, technical innovations, and future perspectives

Abstract

Gastric cancer (GC) ranks among the most common and deadly malignancies globally. Surgical resection with lymph node (LN) dissection is the primary treatment. The accuracy of LN dissection is essential to reduce postoperative complications and mortality. Therefore, improving the quality of LN dissection in GC surgery and refining postoperative LN staging have been the focus of clinical attention. Indocyanine green (ICG) fluorescence imaging serves as a vital clinical tracing technique in GC surgery. It enables accurate tumor localization, enhances the completeness of LN dissection, and evaluates anastomotic blood supply after digestive tract reconstruction. These benefits collectively improve surgical outcomes and lower recurrence rates. This article examines the principles of ICG fluorescence imaging and its necessity in GC tracing surgery. Compared to conventional tracers, ICG offers superior safety and lower toxicity, with robust evidence supporting its clinical efficacy. This technology represents a paradigm shift in GC surgery. Current studies optimize ICG delivery protocols, such as injection time and dose, and integrate it with emerging technologies like robotic systems to improve LN detection rates. This article demonstrates the safety and efficacy of ICG as a tracer, which is poised to advance the precision of GC surgery and improve patient outcomes.

Keywords: Indocyanine green; Fluorescence imaging; Gastric cancer; Lymph node dissection; Near-infrared imaging

Core Tip: The accuracy of lymph node dissection is crucial for reducing postoperative complications and mortality in gastric cancer (GC). Indocyanine green fluorescence staining, as a clinical tracer technique, plays an important role in GC surgery. It enables accurate tumor localization, enhances the thoroughness of lymph node dissection, and facilitates assessment of anastomotic blood supply following digestive tract reconstruction. These functions contribute to improved surgical outcomes and reduced recurrence rates. This review highlights the safety and efficacy of indocyanine green as a tracer, which is expected to enhance surgical precision and improve patient prognosis in GC.