Department of Colorectal Surgery, Fujian Medical University, Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China.
Tech Coloproctol. 2024 Jun 6;28(1):64. doi: 10.1007/s10151-024-02937-z.
This study aimed to investigate the safety and feasibility of indocyanine green near-infrared fluorescence (ICG-NIR) fluorescence-guided video-endoscopic inguinal lymphadenectomy (VEIL) for rectal cancer with inguinal lymph node metastasis (ILNM).
A retrospective analysis was conducted on 11 patients with rectal cancer who underwent ICG-NIR fluorescence-guided VEIL, assessing various parameters such as operation time, intraoperative bleeding, number of harvested lymph nodes, intraoperative and postoperative complications, and follow-up.
Regarding surgical procedures for ILNM, unilateral surgery was performed in 7 cases (54.5%) and bilateral surgery in 4 cases (45.5%). Among these 15 ICG-NIR-guided VEIL surgeries in 11 patients, positive fluorescence visualization was achieved in 13 operations (86.7%). The median estimated blood loss was 10 ml, and the median operation time was 90 min. One case (6.7%) required conversion to open surgery. The median duration of the drain tube was 12 days, and the median length of postoperative hospital stay was 20 days. Postoperative complications were observed, including incisional infection in 2 cases (18.2%), lymphatic leakage in 5 cases (45.5%), urinary infection in 1 case (9.1%), and pneumonia in 3 cases (27.3%). Complications such as skin necrosis, lower limb venous thrombosis, lower limb swelling, or impaired movement were observed during the postoperative follow-up period. No cases of primary lesion, groin, or pelvic lymph node recurrence were observed.
ICG-NIR fluorescence-guided VEIL is a safe and feasible surgical treatment for rectal cancer with ILNM. ICG fluorescence guidance holds promise as a more personalized and precise approach for VEIL in rectal cancer surgery.
本研究旨在探讨吲哚菁绿近红外荧光（ICG-NIR）荧光引导下视频内镜腹股沟淋巴结切除术（VEIL）治疗合并腹股沟淋巴结转移（ILNM）的直肠癌的安全性和可行性。
对 11 例行 ICG-NIR 荧光引导 VEIL 的直肠癌患者进行回顾性分析，评估手术时间、术中出血量、淋巴结清扫数目、术中及术后并发症、随访等各项参数。
11 例患者中，7 例（54.5%）行单侧手术，4 例（45.5%）行双侧手术。在这 11 例患者的 15 次 ICG-NIR 引导 VEIL 手术中，13 次手术（86.7%）实现了阳性荧光可视化。术中估计出血量中位数为 10ml，手术时间中位数为 90min。1 例（6.7%）患者转为开放手术。引流管中位数留置时间为 12d，术后中位住院时间为 20d。术后观察到切口感染 2 例（18.2%）、淋巴漏 5 例（45.5%）、尿路感染 1 例（9.1%）、肺炎 3 例（27.3%）。术后随访期间，观察到皮肤坏死、下肢静脉血栓形成、下肢肿胀或活动受限等并发症，但未观察到原发病灶、腹股沟或盆腔淋巴结复发。
ICG-NIR 荧光引导 VEIL 是治疗合并 ILNM 的直肠癌的一种安全可行的手术治疗方法。ICG 荧光引导有望成为直肠癌 VEIL 更个体化、更精准的方法。
