Visualization of Lymphatic Flow in Laparoscopic Colon Cancer Surgery Using Indocyanine Green Fluorescence Imaging

Abstract

Background: Intraoperative visualization of lymphatic flow could guide surgeons performing laparoscopic colon cancer surgery on the extent of intestinal resection required. The purpose of this study was to investigate indocyanine green fluorescence imaging for intraoperative detection of lymph flow and nodes in such patients.

Methods: All patients undergoing elective laparoscopic surgery for colorectal cancer from October 2016 to July 2017 were included in this study. Indocyanine green was injected submucosally around the tumors via a colonoscope and lymphatic flow assessed with alaparoscopic near-infrared camera system intraoperatively.

Results: Lymph flow was visualized perioperatively in 43 of 57 patients (75.9%). Ten of the 14patients (71.4%) in whom lymphatic flow was not visualized had cStage III or IVcancer and seven (50.0%) had pStage III or IV cancer.

Conclusions: Our findings indicate that the extent of lymphatic node dissection required during laparoscopic resection of colon cancer can be accurately assessed intraoperatively.

Keywords: indocyanine green fluorescence imaging, colorectal cancer, navigation surgery