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      Fluorescence-guided colorectal surgery: applications, clinical results, and protocols

      review-article
      Author(s): 1 , 1 , 2 , 3 , , on behalf of Image-Guided Surgery Study Group of Korean Society of Coloproctology
      Publication date (Electronic):
      Journal: Annals of Surgical Treatment and Research
      Publisher: The Korean Surgical Society
      Keywords: Colorectal surgery, Fluorescent dyes, Indocyanine green

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          Abstract

          In recent years, the rise of minimally invasive surgery has driven the development of surgical devices. Indocyanine green (ICG) fluorescence imaging is receiving increased attention in colorectal surgery for improved intraoperative visualization and decision-making. ICG, approved by the U.S. Food and Drug Administration in 1959, rapidly binds to plasma proteins and is primarily intravascular. ICG absorption of near-infrared light (750–800 nm) and emission as fluorescence (830 nm) when bound to tissue proteins enhances deep tissue visualization. Applications include assessing anastomotic perfusion, identifying sentinel lymph nodes, and detecting colorectal cancer metastasis. However, standardized protocols and research on clinical outcomes remain limited. This study explores ICG’s role, advantages, disadvantages, and potential clinical impact in colorectal surgery.

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          Most cited references80

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          Tumor vascular permeability and the EPR effect in macromolecular therapeutics: a review

          Allyn Maeda, J. J. Wu, T Sawa … (2000)
          Article 0 comments Cited 483 times – based on 0 reviews     Review now
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            Neoadjuvant (Chemo)radiotherapy With Total Mesorectal Excision Only Is Not Sufficient to Prevent Lateral Local Recurrence in Enlarged Nodes: Results of the Multicenter Lateral Node Study of Patients With Low cT3/4 Rectal Cancer

            Atsushi Ogura, Tsuyoshi Konishi, Chris Cunningham … (2019)
            Purpose Improvements in magnetic resonance imaging (MRI), total mesorectal excision (TME) surgery, and the use of (chemo)radiotherapy ([C]RT) have improved local control of rectal cancer; however, we have been unable to eradicate local recurrence (LR). Even in the face of TME and negative resection margins (R0), a significant proportion of patients with enlarged lateral lymph nodes (LLNs) suffer from lateral LR (LLR). Japanese studies suggest that the addition of an LLN dissection (LLND) could reduce LLR. This multicenter pooled analysis aims to ascertain whether LLNs actually pose a problem and whether LLND results in fewer LLRs. Patients and Methods Data from 1,216 consecutive patients with cT3/T4 rectal cancers up to 8 cm from the anal verge who underwent surgery in a 5-year period were collected. LLND was performed in 142 patients (12%). MRIs were re-evaluated with a standardized protocol to assess LLN features. Results On pretreatment MRI, 703 patients (58%) had visible LLN, and 192 (16%) had a short axis of at least 7 mm. One hundred eight patients developed LR (5-year LR rate, 10.0%), of which 59 (54%) were LLRs (5-year LLR rate, 5.5%). After multivariable analyses, LLNs with a short axis of at least 7 mm resulted in a significantly higher risk of LLR (hazard ratio, 2.060; P = .045) compared with LLNs of less than 7 mm. In patients with LLNs at least 7 mm, (C)RT plus TME plus LLND resulted in a 5-year LLR of 5.7%, which was significantly lower than that in patients who underwent (C)RT plus TME (5-year LLR, 19.5%; P = .042). Conclusion LLR is still a significant problem after (C)RT plus TME in LLNs with a short axis at least 7 mm on pretreatment MRI. The addition of LLND results in a significantly lower LLR rate.
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              Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection: results of a multicenter randomized controlled trial.

              Paola De Nardi, Ugo Elmore, Giulia Maggi … (2020)
              Insufficient vascular supply is one of the main causes of anastomotic leak in colorectal surgery. Intraoperative indocyanine-green (ICG) angiography has been shown to provide information on tissue perfusion, identifying a well-perfused location for colonic and rectal transections, and thus possibly reducing the leak rate. Aim of this study was to evaluate the usefulness of intraoperative assessment of anastomotic perfusion using ICG angiography in patients undergoing left-sided colon or rectal resection with colorectal anastomosis.
              Article 0 comments Cited 88 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Surg Treat Res
                Journal ID (iso-abbrev): Ann Surg Treat Res
                Journal ID (publisher-id): ASTR
                Title: Annals of Surgical Treatment and Research
                Publisher: The Korean Surgical Society
                ISSN (Print): 2288-6575
                ISSN (Electronic): 2288-6796
                Publication date (Print): November 2023
                Publication date (Electronic): 31 October 2023
                Volume: 105
                Issue: 5
                Pages: 252-263
                Affiliations
                [1 ]Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
                [2 ]Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
                [3 ]Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
                Author notes
                Corresponding Author: Gyung Mo Son. Department of Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea. Tel: +82-55-360-2124, Fax: +82-55-360-2154, skm1711@ 123456pusan.ac.kr
                Author information
                https://orcid.org/0000-0002-5318-3432
                https://orcid.org/0000-0001-5355-3969
                https://orcid.org/0000-0002-4559-2690
                https://orcid.org/0000-0002-8861-6293
                Article
                DOI: 10.4174/astr.2023.105.5.252
                PMC ID: 10648611
                PubMed ID: 38023438
                SO-VID: 0a47f4d7-665c-495a-ab11-b7e08ae4b3e1
                Copyright © Copyright © 2023, the Korean Surgical Society
                License:

                Annals of Surgical Treatment and Research is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 29 September 2023
                Date revision received : 09 October 2023
                Date accepted : 10 October 2023
                Categories
                Subject: Review Article
                Subject: Colorectal

                Keywords: colorectal surgery,fluorescent dyes,indocyanine green
                Data availability:
                Keywords: colorectal surgery, fluorescent dyes, indocyanine green

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