Qiu Wenlong, Hu Gang, Mei Shiwen, Li Yuegang, Quan Jichuan, Niu Huiyong, Mei Lan, Jin Shangkun, Liu Qian, Tang Jianqiang
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
Clinical Medical College, Hebei University, 071002, Hebei, China.
Eur J Surg Oncol. 2025 Mar;51(3):109520. doi: 10.1016/j.ejso.2024.109520. Epub 2024 Dec 22.
Fluorescence-guided lymphadenectomy (FLND) using indocyanine green (ICG) has emerged as a promising technique to enhance the accuracy of lymphadenectomy in rectal cancer surgery. Effective lymphadenectomy is crucial for improving prognosis in patients with advanced rectal cancer, but it remains technically challenging and controversial.
This prospective nonrandomized controlled study was conducted involving 129 patients underwent laparoscopic surgery, and 64 patients assisted by FLND. Patients received submucosal ICG injections before surgery to facilitate FLND. Lymph nodes were categorized as station 251, station 252, or station 253 based on their anatomical locations. The effectiveness of FLND was evaluated by comparing the number of harvested and metastatic lymph nodes between the FLND and control groups.
The FLND group demonstrated a significantly higher median number of harvested station 253 lymph nodes compared to the control group (2.0 vs. 1.0, P = 0.007). The FLND cohort had a shorter postoperative hospital stay (6 days vs. 8 days, P < 0.001) and similar rates of postoperative complications compared to the control cohort. The study found no significant differences in the median number of harvested station 251 (10.0 vs. 11.0, P = 0.872) and station 252 (6.0 vs. 5.0, P = 0.369) lymph nodes between the groups. Univariate and multivariate analyses indicated that FLND significantly increased the harvested lymph node count.
Radical surgery assisted by FLND significantly improves the accuracy and yield of lymphadenectomy in mid-low rectal cancer, enhancing surgical outcomes and patient prognosis. Future advancements in fluorescence imaging and related technologies hold promise for further improving the clinical effectiveness of this technique.
使用吲哚菁绿（ICG）的荧光引导淋巴结清扫术（FLND）已成为一种有前景的技术，可提高直肠癌手术中淋巴结清扫的准确性。有效的淋巴结清扫对于改善晚期直肠癌患者的预后至关重要，但在技术上仍具有挑战性且存在争议。
本前瞻性非随机对照研究纳入了129例行腹腔镜手术的患者，其中64例接受了FLND辅助手术。患者在手术前接受黏膜下ICG注射以促进FLND。根据淋巴结的解剖位置将其分为251组、252组或253组。通过比较FLND组和对照组之间收获的淋巴结数量和转移淋巴结数量来评估FLND的有效性。
与对照组相比，FLND组收获的253组淋巴结中位数显著更高（2.0对1.0，P = 0.007）。与对照组相比，FLND队列的术后住院时间更短（6天对8天，P < 0.001），术后并发症发生率相似。研究发现两组之间收获的251组淋巴结中位数（10.0对11.0，P = 0.872）和252组淋巴结中位数（6.0对5.0，P = 0.369）无显著差异。单因素和多因素分析表明，FLND显著增加了收获的淋巴结数量。
FLND辅助的根治性手术显著提高了中低位直肠癌淋巴结清扫的准确性和收获量，改善了手术效果和患者预后。荧光成像及相关技术的未来进展有望进一步提高该技术的临床有效性。
