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Background <p>Patients with lateral lymph node metastasis (LLNM) present particular challenges for both diagnosis and treatment. This study aimed to assess whether indocyanine green (ICG)-assisted lymph node mapping with near-infrared imaging (NIRI) enhances the effectiveness of lateral lymph node dissection (LLND) by further categorizing the lateral lymph nodes in patients with mid-low rectal cancer.</p> Methods <p>Submucosal indocyanine green injection was performed on the distal margin of the rectal cancer. In the ICG-LLND group, the lymphatic drainage pathway and distribution of lateral lymph nodes (LLNs) were explored using a laparoscopic NIRI system. Pathological evaluations were conducted for both the ICG-LLND group and the control group.</p> Results <p>The ICG-LLND group demonstrated a significantly shorter postoperative hospital stay compared to the control group, both before (<i>P</i>&#xa0;&lt;&#xa0;0.001) and after (<i>P</i>&#xa0;=&#xa0;0.001) matching. While blood loss and operating time were similar between groups, the ICG-LLND group had fewer cases of anastomotic leakage (<i>P</i>&#xa0;=&#xa0;0.206). Postoperative lymph node harvesting was significantly higher in the ICG-LLND group, with more total lymph nodes (<i>P</i>&#xa0;=&#xa0;0.001) and lateral lymph nodes (<i>P</i>&#xa0;=&#xa0;0.002) harvested. The number of harvested lymph nodes in the obturator and internal iliac regions was also higher in the ICG-LLND group (<i>P</i>&#xa0;=&#xa0;0.001), and the number of positive lymph nodes in these regions was significantly greater before (<i>P</i>&#xa0;=&#xa0;0.027) and after (<i>P</i>&#xa0;=&#xa0;0.013) matching. Univariate and multivariate analyses showed that ICG-LLND, nCRT, and positive pN stage were associated with increased lymph node harvest.</p> Conclusions <p>ICG-LLND improved lateral lymph node harvest, particularly obturator lymph nodes, and shortened postoperative hospital stay without increasing complications. This technique may enhance surgical outcomes in patients requiring lymph node dissection.</p>

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Fluorescence lymph node mapping using ICG improves lateral lymph node dissection for mid-low rectal cancer: a propensity score-matched cohort

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月13日

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  • W. Qiu,
  • H. Niu,
  • G. Hu,
  • S. Mei,
  • Y. Li,
  • Y. Wang,
  • L. Mei,
  • W. Zhao,
  • J. Liu,
  • J. Tang,
  • Q. Liu

摘要

Background

Patients with lateral lymph node metastasis (LLNM) present particular challenges for both diagnosis and treatment. This study aimed to assess whether indocyanine green (ICG)-assisted lymph node mapping with near-infrared imaging (NIRI) enhances the effectiveness of lateral lymph node dissection (LLND) by further categorizing the lateral lymph nodes in patients with mid-low rectal cancer.

Methods

Submucosal indocyanine green injection was performed on the distal margin of the rectal cancer. In the ICG-LLND group, the lymphatic drainage pathway and distribution of lateral lymph nodes (LLNs) were explored using a laparoscopic NIRI system. Pathological evaluations were conducted for both the ICG-LLND group and the control group.

Results

The ICG-LLND group demonstrated a significantly shorter postoperative hospital stay compared to the control group, both before (P < 0.001) and after (P = 0.001) matching. While blood loss and operating time were similar between groups, the ICG-LLND group had fewer cases of anastomotic leakage (P = 0.206). Postoperative lymph node harvesting was significantly higher in the ICG-LLND group, with more total lymph nodes (P = 0.001) and lateral lymph nodes (P = 0.002) harvested. The number of harvested lymph nodes in the obturator and internal iliac regions was also higher in the ICG-LLND group (P = 0.001), and the number of positive lymph nodes in these regions was significantly greater before (P = 0.027) and after (P = 0.013) matching. Univariate and multivariate analyses showed that ICG-LLND, nCRT, and positive pN stage were associated with increased lymph node harvest.

Conclusions

ICG-LLND improved lateral lymph node harvest, particularly obturator lymph nodes, and shortened postoperative hospital stay without increasing complications. This technique may enhance surgical outcomes in patients requiring lymph node dissection.