Qiu Wenlong, Zhou Cheng, Zhao Wei, Mei Shiwen, Liu Qian
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, Beijing, 100021, People's Republic of China.
Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China.
Updates Surg. 2025 Apr 9. doi: 10.1007/s13304-025-02169-2.
Local advanced rectal cancer (LARC) carries high recurrence risks, especially with lateral lymph node (LLN) involvement. This study aims to evaluate the role of ICG-guided sentinel lymph node biopsy (SLNB) in patients with clinical negative LLNs (maximum diameter < 7 mm), potentially reducing unnecessary surgeries and associated complications in patients with LARC. A retrospective analysis of 301 consecutive patients with lower LARC who underwent fluorescent lateral pelvic sentinel lymph node biopsy (FL-SLNB) or conventional LLND at the Cancer Hospital, Chinese Academy of Medical Sciences between 2018 and 2022 was conducted. Clinical and pathological data were collected, and the patients were grouped into FL-SLNB and non-SLNB groups. Postoperative complications, recurrence rates, and survival outcomes were assessed. Statistical analysis was performed using χ tests, Mann-Whitney U tests, Kaplan-Meier survival curves, and Cox proportional hazards models. FL-SLNB (173 patients) showed better perioperative outcomes than non-SLNB (128 patients), with shorter hospital stays (7 vs. 10 days, P = 0.027), less blood loss (150 vs. 180 mL, P = 0.032), and fewer complications: intraoperative bleeding (2.9% vs. 6.3%, P = 0.041), anastomotic leakage (1.7% vs. 3.9%, P = 0.045), and urinary dysfunction (3.5% vs. 7.0%, P = 0.039). No significant differences were observed in survival or recurrence rates (P > 0.05). pN stage was a significant predictor of distant metastasis (HR 1.953, P = 0.037). ICG-guided SLNB enhanced surgical precision and reduced unnecessary LLND in lower LARC with clinically negative LLNs, and improved surgical decision-making and minimizes postoperative complications.
局部进展期直肠癌（LARC）具有较高的复发风险，尤其是伴有侧方淋巴结（LLN）转移时。本研究旨在评估吲哚菁绿（ICG）引导下前哨淋巴结活检（SLNB）在临床LLN阴性（最大直径<7mm）患者中的作用，可能减少LARC患者不必要的手术及相关并发症。对2018年至2022年在中国医学科学院肿瘤医院连续接受荧光侧盆腔前哨淋巴结活检（FL-SLNB）或传统LLN清扫术（LLND）的301例低位LARC患者进行回顾性分析。收集临床和病理数据，将患者分为FL-SLNB组和非SLNB组。评估术后并发症、复发率和生存结局。采用χ检验、Mann-Whitney U检验、Kaplan-Meier生存曲线和Cox比例风险模型进行统计分析。FL-SLNB组（173例患者）的围手术期结局优于非SLNB组（128例患者），住院时间更短（7天对10天，P=0.027），失血量更少（150ml对180ml，P=0.032），并发症更少：术中出血（2.9%对6.3%，P=0.041）、吻合口漏（1.7%对3.9%，P=0.045）和排尿功能障碍（3.5%对7.0%，P=0.039）。生存或复发率未见显著差异（P>0.05）。pN分期是远处转移的显著预测因素（HR 1.953，P=0.037）。ICG引导下的SLNB提高了手术精准度，减少了低位LARC伴临床LLN阴性患者不必要的LLND，并改善了手术决策，使术后并发症降至最低。
